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1 A brief history of reflexology

Healing by touch is as old as mankind. It requires insight, intuition and the use of specialized skills and techniques.

The word ‘massage’ comes from the ancient Arabic word ‘mass’, meaning ‘to touch or palpate’. Touch or massage has historically been used as a restorative to bring back health and strength. Many of the touch therapies are based on the theory that for good health the body’s energy must flow unimpeded, or that a holistic and integrated approach to maintain health should be followed. For instance, Hippocrates (460–375 BC) advocated a system of treatment that incorporated diet, fresh air and exercise (or gymnastics, as they were known then) and advised massage, or rubbing an area of the body, as a therapeutic relaxation.

This chapter examines the ancient and recent origins of reflexology, both in the West and in the Orient, and the recent development of the zone concept.

Egyptian origins

The Egyptian origins of reflexology can be seen in a frieze at the tomb of Ankhmahor that is thought to illustrate a reflexology treatment taking place (figures 1.1 and 1.2). This tomb in Saqqara is known as the ‘physician’s tomb’ owing to the marvellous portrayal of many medical scenes found on its walls. The tomb was discovered by V Loret in Egypt in 1897. Saqqara is one of the richest archaeological sites in Egypt, containing monuments constructed over a span of more than 3,000 years, the earliest being the Mastabas, the earlier name for a tomb. Saqqara is the largest necropolis found (a large burial ground of the ancient city). Activity was extremely intense in this area during the Old Kingdom.

The Old Kingdom encompassed the period from the 1st to the 6th Dynasty when all the great pyramids were built in Giza and in Saqqara this period lasted from 3000 to 2250 BC when it came abruptly to an end, owing to a civil war breaking out, and the whole empire collapsed. To the Ancient Egyptians the afterlife was just as important as the earthly life, hence the reason they surrounded themselves with many murals and pictures on the walls of their many tombs; these portray agricultural scenes and abundant harvests as well as hunting, fishing and dancing scenes and many games. All of these were of an afterlife modelled on a visionary earthly life. Ankhmahor was an able master-builder and was considered an expert because he controlled the work of the many sculptors at the tomb. This project disclosed his keen interest in medicine as he displayed recurrent images of medical themes and surgical operations taking place on the walls. His interest in pathology was attributed to his admiration of another architect named Imhotep, who was made an object of worship and was later known as Imuthes, God of Medicine. (Imhotep built the first step pyramid for King Zoser the Pharaoh of the 3rd Dynasty in 2686 BC when Zoser was the King of Upper and Lower Egypt.)

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Figure 1.1 Illustration of patients having hands and toes treated (lower picture) and a patient having hand treatment (top picture), from the tomb of Ankhmahor.

In the Masataba of ‘Ankhmahor’ on the west door entrance are two registers representing the treatment of hands and feet. These are referred to as a manicure and pedicure by Alexander Badawy in his book The Tomb of Ankhmahor at Saqqara in which he gives a very fine detailed translation of the wall scenes. In one scene on the wall the right hand of one person is being treated and the other person is having a toe on the left foot treated. The text reads: (patient) ‘Make these give strength.’ The operator responds, ‘I will do to thy pleasure sovereign!’ (This answer is between the two operators, so it could be valid for both.) The patient who is having his toe treated is begging, ‘Do not cause pain to these.’ There also appears to be a probe in the operator’s hand (see figure 1.1) (although this is not shown in the many reproduced copies that are included in many reflexology books). An upper fragment on the same wall shows a patient having both hands treated; however, the inscription was badly defaced (see figure 1.1).

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Figure 1.2 Patients having massage or manipulation of the foot or leg and shoulder, from the tomb of Ankhmahor.

Another relief shows massage or manipulation to the foot or leg and shoulder (figure 1.2), which could indicate some form of pressure therapy. As massage was often mentioned in many of the texts and old medical papyri it is quite reasonable to believe that this could be a form of reflexology treatment taking place on the hands and feet with massage or manipulation to the legs and back.

Ankhmahor himself is represented on two door-jambs in identical striding attitude. The inscriptions indicate the many titles he held; these include ‘Hereditary Prince’, ‘Count’, ‘Chief Justice’, ‘Vizier’ and ‘Court Physician’.

Chinese origins

Ancient Chinese writings described a pressure therapy using the fingers and thumbs. Acupressure is an old Oriental therapy, ‘acu’ meaning ‘needle point’; however, finger pressure was used long before needles. There are different types of acupressure, from the very gentle to deep digital and thumb pressure. There were many early books written on massage or ‘examining foot method’ as it was then called. In reflexology, the varying pressures are used according to each individual’s requirements and the diagnostic techniques are very similar to those used in Chinese acupressure.

In the Sung Dynasty (AD 960–1280) a paper that first appeared in Essentials of Preserving Life showed some exercise routines, which, when repeated, were supposed to be excellent for health. One of these routines was to stretch the hands forward and clench firmly the balls of the extended feet and lower the head as if paying homage; this was repeated 12 times, after which you then returned to the crossed leg position and placed your clenched hands back into your lap. Many ancient diagrams survived of these early ‘Dao Yin’ exercises that were the earliest forms of Chi Kung (Qigong); these were traditionally considered representations from the Chinese ancients of longevity each of whom had their own special method of healing diseases. One in particular is an acupressure cure for lumbago or any low back pain; it shows the person facing the wall, pressing the palm of the right hand against the wall, letting the left hand drop naturally; the right foot is also placed against the wall, and the person then proceeds to exhale very slowly 18 times. This is then repeated with the left hand and foot. This exercise is claimed to heal strain of the lumbar muscles, and relieve lower back pain and lumbago. These actions indicate how important the hands and feet are considered to be in maintaining good health in TCM.

Acupuncture itself developed throughout the early Shang Dynasty in the 16th to 11th centuries BC. It became a method of treating disease and pain by the insertion of many different types and sizes of needles into specific areas of the body. These areas, or acupuncture points (acupoints), were thought to lie on lines or channels known as meridians (see chapter 2 for a full description). Acupressure and acupuncture were, however, only a small part of the treatment of TCM. The system also included a vast herbal tradition and dietary practices.

Buddhism was a religion of East and Central Asia that grew from the teachings of Gautama Buddha. His philosophy was that pureness of spirit was the answer to all suffering. Buddhism spread to China around the time of the Han Dynasty (about 206 BC). There is evidence from this period that in ancient times the feet symbolized many things. A Buddha’s footprints carved in the rock at Kusinara, China, shows signs on the second, third, fourth and fifth toes depicting the Sun, in ancient times possibly symbolizing the Qi energy within the toes (see figure 1.3).

Yin, Yang and Qi

The terms ‘Yin’ and ‘Yang’ are widely used in Traditional Chinese Medicine. They describe, for instance, the quality of the Qi (Chi) energy, which flows through channels called meridians. Illness is caused by an imbalance of Yin and Yang in the body. The idea of Yin and Yang polarities appears continually throughout Chinese thought. Yin is conceived as the soft, inactive female principle or polarity in the body and in the universe generally, while Yang is the active, male principle or polarity. Although opposites, they are also interrelated, and to keep healthy these two opposing but complementary energies must always be balanced.

One energy ascends in the body; the other descends. TCM theory states that if the blood and the energy are not in equilibrium, there is disharmony between the Yin and Yang qualities, and illness will soon follow. A blockage or malfunction is considered to indicate a deficiency or excess of energy of one or the other within the body, manifesting as a functional disturbance, or an imbalance in the way in which an organ or body system functions; from this, physical ill-health can develop. A saying that describes this idea is ‘If there is a kink in the life force disease will manifest’. In disease these terms also refer to Yang being all acute problems, in which the patient feels hot and may have a temperature, and is restless. Yin indicates a more chronic problem, in which the patient is weak and often cold and has no wish to move about.

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Figure 1.3 Buddha’s foot, showing the Sun sign on the toes, possibly indicating Qi.

Good health depends on the correct balance between these two opposites, the negative and positive. To follow the general principles of Yin and Yang one needs also to be aware of the environment and the changes of the season; all of the above had to be taken into consideration to preserve life. Today China is known for its many centenarians, and longevity is something all Chinese people cherish; many feel that it can be attained through correct living and the use of TCM principles.

The Zang-fu organs and the meridians

TCM theory divides the body into 12 organ systems, 6 of which are Yang (Fu or hollow organs): Stomach, Small Intestine, Large Intestine, Bladder, Gall Bladder and Triple Burner (or Triple Heater or Triple Energizer), and 6 of which are Yin (Zang or solid organs): Heart, Liver, Spleen (and Pancreas), Lungs, Kidneys and Pericardium. Together they are called the Zang-fu.

Each of the Zang organs is related to one of the Fu organs. So there are six pairs. Often when treating a patient, these Yin and Yang organs can be coupled together because they are so closely related, and treatment of one will often affect the other. The pairs are: the Liver and Gall Bladder, the Spleen and Stomach, the Lungs and Large Intestine, the Kidneys and Bladder, the Heart and Small Intestine, and the Pericardium and Triple Burner. The Triple Burner (Sanjiao) regulates the functioning of all the Zang-fu organs; it also acts as a passageway for the movement of all fluids.

The organs are also designated according to the Five Elements theory. According to ancient Chinese traditions, the elements comprise Wood, Fire, Earth, Metal and Water. These elements are thought to influence each other, in a cyclical manner.

The balance of Yin and Yang within each of the above organ systems is regulated and influenced by the Yin-Yang balance of the Qi flowing through the meridians connected with them. This Qi is particularly easy to influence for the purposes of treatment at particular points called acupuncture points (or acupoints). Acupoints at the extremities (hands and feet) are thought to be the most powerful to use (see figure 1.9).

There are 12 major meridians in the body and limbs, each connected to one organ system; 6 connect the hands with the face or chest, and 6 connect the feet with the face or chest. These meridians are often classified in three ways:

       1. According to their cycle of energy. This is as follows: Lungs, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidneys, Pericardium, Triple Burner, Gall Bladder, Liver. The cycle of energy goes: hands-hands, feet-feet, hands-hands, feet-feet, hands-hands, feet-feet; we can balance the energy by working on this theory.

       2. According to the division of the two groups into Yin and Yang: the Yin meridians of the feet and legs are: the Liver, Spleen and Kidneys – these ascend from the feet to the breast (figure 1.4) the Yin meridians of the hands and arms are: Lungs, Heart, Pericardium – these descend from the breast to terminate in the fingers (figure 1.5)
the Yang meridians of the hands and arms are: Large Intestine, Small Intestine and Triple Burner – these ascend from the fingers to the face (figure 1.6)
the Yang meridians of the feet and legs are: the Stomach, Bladder, Gall Bladder – these descend from the face to the toes (figure 1.7).

       3. According to where they are located: the six meridians on the hands and arms include the Lungs, Large Intestine, Pericardium, Triple Burner, Heart and Small Intestine. The six meridians on the feet and legs are the Kidneys, Spleen, Liver, Stomach, Gall Bladder and Bladder.

There is an involved association between an organ and a meridian. They are often paired together because of the anatomical closeness of the corresponding meridian, which links the Yin and the Yang organ. In reflexology this opposite point becomes an area of assistance to work.

We begin to see a combination between the groups as follows:

       •  The three Yin meridians descend from the breast area to the hands (see figure 1.5); that is the Lungs, Heart and Pericardium, (for details of each meridian pathway see figures 2.8–2.20).

       •  The three Yang meridians of the hands ascend from the hand to the face (see figure 1.6) that is the Large Intestine, Small Intestine and Triple Burner.

       •  The three Yin meridians of the feet ascend from the feet to breast area (see figure 1.4); that is the Spleen, Kidneys and Liver.

       •  The three Yang meridians of the feet descend from the face to the feet (see figure 1.7); that is the Stomach, Bladder and Gall Bladder.

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Figure 1.4 The three ascending Yin meridians of the feet (Spleen, Liver and Kidneys)

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Figure 1.5 The three descending Yin meridians of the hands (Lungs, Heart and Pericardium)

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Figure 1.6 The three ascending Yang meridians of the hands (Large Intestine, Triple Burner and Small Intestine)

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Figure 1.7 The three descending Yang meridians of the feet (Stomach, Bladder and Gall Bladder)

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Figure 1.8 (a) Eight major meridians converge on the face. (b) The face has three originating points, three terminating points, and two terminating points from the vessels.

There are many interactions between the organs and meridians, and they are paired in many ways. Some old doctrines link the Yin organs in a cycle, and then the Yang organs, in a theory that attempts to describe the movement of Qi energy. One idea is that there is an area of the body where Qi undergoes a fundamental change in polarity, where Yin is converted into Yang or vice versa (figure 1.9). One speculation is that at such an area or point the therapist gets a much more positive result, because the energy is unstable and nearer to the surface here. However, there are areas which contain the points where the ascending Yang meridians terminate on the face and where the descending Yang meridians originate from prior to descending to the feet: these are thought to be more stable yet not so potent. Yet if this is so, why is it that these facial distal points are so powerful? It is important to note that there are eight major meridians converging on the facial area (see figures 1.8a and 1.8b, and chapter 7). Is this why the ears, head and facial points are so effective? This interchange of energies takes place on the fingers of the upper limbs as the Yin energy is near its end, and the Yang energy is about to commence; this fluctuation extends from the fingers to the elbow. So we see the three Yin meridians conveying their energy to the three Yang meridians, anywhere in this area. This leads to the traditional pairing of these organs on the hand:

       •  Lungs (Yin) paired with Large Intestine (Yang)

       •  Heart (Yin) paired with Small Intestine (Yang)

       •  Pericardium (Yin) paired with Triple Burner (Yang).

The same metamorphosis takes place on the feet, with the area from the tips of the toes to the knee being the most advantageous area to work, and around the ankles being very potent. Again, a pairing of the Yin and Yang meridians takes place:

       •  Stomach (Yang) paired with Spleen (Yin)

       •  Bladder (Yang) paired with Kidneys (Yin)

       •  Gall Bladder (Yang) paired with Liver (Yin).

It is important when treating always to balance these points, incorporating pressure points of both upper and lower limbs. This stabilizes the energy from the upper part of the body with that of the lower part of the body. The combination of such points is very forceful and effective, so working upper pressure points with lower pressure points or working on the paired organ becomes a powerful therapy.

The Chinese often utilize these combination points according to their forceful action or their compatibility. The meridian channels form a complete circuit and TCM principles state that these energies within each meridian are balanced; hence, on that account they have always been used in treatment. The points on the extremities are referred to as the fountain head or well points (figure 1.9), for instance those at the tips of the fingers and the tips of the toes, and KI-1 located at the centre of the ball of the foot. These are considered to be extremely powerful as they are barely skin deep at this terminal or starting point, so they are easy to stimulate by palpation as is done in reflexology. The spring points are extremely potent and forceful; these are found around the wrist and the ankles, with the feet points being more dynamic than those of the hands. At the sea points, which lie at the elbows or knees, the energy is more general and less active, achieving a slower response.

Recent history

When the People’s Republic of China was formed in 1949 TCM came under threat because of superstitions and ancient theories and was almost lost. It was Chairman Mao who came to the rescue. The story goes that he became very ill and orthodox medicine did not help him, so he turned to the traditional folk medicine, which saved him. Following this, he declared ‘Traditional Chinese Medicine is of immense value, it needs to be constantly explored and further developed’. Because of this, since 1950 work was encouraged on research and tests on TCM, and Western medicine and TCM were practised side by side. Research on TCM has continued in China and has been maintained over the last 40 years and more recently they have also researched treatment by reflexology. To date the China Reflexology Association have accumulated over 10,000 case histories on reflexology treatments. There are 31 provinces in China, half of which have set up a reflexology branch. Among 7,000 members of the national and the local associations, there are now over 1,500 medical doctors in China who practise reflexology in their hospitals, or clinics, sanatoriums, and other centres.

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Figure 1.9 The most potent areas to work

The history of the zone concept

The founder of zone therapy

Zone therapy is a system discovered many years ago by an eminent American physician, William H Fitzgerald, who was born in 1872 and who died in Stamford, Connecticut on 21 October 1942. He was an MD in Hartford, Connecticut. Dr Fitzgerald graduated from the University of Vermont in 1895 and worked his first 21/2 years at the Boston City Hospital; he then went on to serve a further 2 years at the Central London Ear, Nose and Throat (ENT) Hospital in England (1902). This was followed by a further 2 years in Vienna’s ENT Hospital under Professor Politzer and Professor Otto Chiari, who were well known in the medical world at that time. All of this gives some indication of Dr Fitzgerald’s qualities as a doctor and surgeon. Dr Fitzgerald was senior nose and throat surgeon at St Francis Hospital, Hartford, Connecticut for several years. It was during that period that he made his findings of zone therapy, as it was called at this time, known to the medical world.

He developed this therapy because he observed, while working, that when applying pressure over certain points of the toes and hands, and other parts of the body, if the pressure was firm enough it caused a type of anaesthesia in a limited area. This enabled him to perform minor operations on the nose and throat without using cocaine and other local analgesics while the patient could be treated without pain. Fitzgerald stated in his book that pressure over any bony eminence, or upon the zones corresponding to the location of the injury, would tend to relieve pain, and that not only would it relieve pain but if pressures were firm enough it would produce an anaesthetic effect, often removing the cause of the pain.

Dr Fitzgerald published his first book in 1917 with Dr Edwin Bowers. The title read ‘Zone Therapy, or Relieving Pain at Home’. In this he related all his important findings on zone therapy. A zone is an area or part that is marked off, with stated qualities. Fitzgerald diagrammatically depicted this in his early drawings by dividing the human body into zones both anterior and posterior (figure 1.10) and he speculated that the body could be divided into ten such longitudinal (meaning vertical) zones, five each side of the median or middle line. The first ran from the medial edge of the great toe through the centre of the nose to the brain, and then out to the thumb or vice versa. He spoke of these zones as numbering one to five on the right side of the body and the same on the left side. He called them ‘ten invisible currents of energy through the body’ in line with the fingers and toes. (Note that the zones extended from the toe to the brain and out to the thumb or fingers or vice versa, not from the brain to the toe and brain to fingers, as stated in some books.) Fitzgerald also said that his five lines marked out and represented the centre of the respective zones. (Many books do not show this but instead depict four lines coming from each of the webs of the toes, showing the digits as the ten zones.) He then demonstrated the correlation between areas in distant parts of the body and how pressure of between 2 and 10 pounds on given fingers or toes would alleviate pain anywhere in a particular zone. He also stated that the upper and lower surfaces of the joint and side areas must all be pressed for good results (figure 1.11). Each zone could be worked on either hands or feet because the zones ran either way. The distance between the area treated and the organ was of no importance as the whole zone would be treated.

Fitzgerald outlined how pressure over the great toe or on the corresponding thumb helped the entire first zone; this first zone included the incisors and cuspid teeth, and an analgesic effect would often be felt throughout the zone. The second zone included the bicuspid and the third zone the two molars (knowing the zonal pathway enables you to work on the corresponding area for teeth problems). He stated that zones 4 and 5 usually merged in the head. The shoulder and axilla were in all five zones. Also he considered that in zone 4 was the middle ear. (My opinion is that the eustachian tube and middle ear combined are in zones 3 and 4.)

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Figure 1.10 (a) The zones of the body according to Dr William Fitzgerald. (b) Corresponding longitudinal and lateral zones in the body and the foot.

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Figure 1.11 Applying pressure to all surfaces of the finger

Zone therapy demonstrates the correlation and interdependence of all parts of the body. In his chapter ‘Zone therapy – for doctors only’, Fitzgerald commented: ‘six years ago I accidentally discovered that pressure with a cotton-tipped probe in the mucocutaneous margin of the nose gave an anaesthetic result’. He also went on to explain about how pressure on hands and feet and over joints reproduced the same characteristic results in pain relief. He stated that, when the pain was relieved, the condition that produced the pain was most generally relieved also, and that this led to the ‘mapping out’ of these various areas and associated connections and also to the conditions influenced through them.

He wrote that clasping the hands firmly was effective for many conditions including nervousness, anxiety, insomnia. Also clasping them for 10 minutes would help all pulmonary problems and even the common cold, while changing the clasp position from one hand to the other for 10 minutes each time would help to relieve many minor symptoms and in some cases even more involved problems.

He stated that neck and thyroid problems could be relieved by using distal pressures on the base of the first phalanx of the great toe or thumb and second and third digits respectively. (This was clearly stated so that errors in later books should not arise.) For lumbago one should work on the edge of the palm in line with the ring and little finger, but the most rapid relief for sciatica was secured by attacking the soles of the feet. Fitzgerald often spoke of curing lumbago with a comb; his instructions were to press the teeth into the palmar surface of the thumb first and then the second and third fingers and occasionally work on the webs, especially between thumb and first finger, and to work even the very tops of fingers and right up to wrists as this would help the entire zone. The palmar surface of the hands was to be attacked for pains in the back of the body and the dorsal or top surfaces of hands and fingers for any problems in the anterior (front) surface of body.

He added that, for eye problems, pressure could be applied to the index finger and sometimes middle finger if the eyes were set far apart. He spoke of squeezing the big finger or corresponding toe for ear problems. Pictures showed the distal phalange being squeezed by thumb and forefinger, or tight elastic bands being placed around them; one of the most effective methods for ear problems was placing a clothes peg to the tip of the ring finger or the fingers on either side, or raising the nail of the fourth finger for tinnitus. This point is a known acupuncture point (see figure 6.8b).

Pressure was often applied using aluminium combs, pointed instruments, tight elastic bands, clothes pegs or clamps on the fingers or toes (figure 1.12). Fitzgerald also spoke of how to use pressure with fingers and thumbs from anything between 1 and 4 minutes. The use of the many non-electrical applications such as surgical clamps, aluminium combs, elastic bands, pegs and percussion motors never really caught on because they were so invasive. Fitzgerald also had ‘therapy bites’ and ‘therapy grips’; these were saw-edged articles or sometimes just metal combs. He even used rubber erasers. However, hands and the precise techniques of the correct pressure were all that was really needed.

He stated how all the zones must be free from irritation and obstructions to get the best results. His writings spoke of how important teeth were and how they should be preserved, also how offending corns, warts, calluses, etc. created an inflammatory process, which could cause a problem in a corresponding part of the body, how fingernails and toenails should be kept trimmed and how too much pressure from shoes could be detrimental to health within that zone.

Fitzgerald gave four different reasons in his book for how zone therapy worked (this is also outlined in the book Reflexology: Art, Science and History by Christine Issel). He stated:

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Figure 1.12 (a) A method of treating earache, toothache and any pain. (b) Combs applied to the fingers to treat complications of the mid-thoracic and lower back, and other deep-seated problems.

while we know the fact of pain relief, through the laying on of the hands, or by kindred measures, we only know part of its reason for operation. There are several of these. They are:

1 Through the soothing influence of animal magnetism

2 The manipulation of the hand over the injured place tends to prevent a condition of venous stasis

3 Pressure over the seat of injury produced ‘blocked shock’ or ‘nerve block’ which meant that by pressing on the nerves running from the injured part to the brain area we inhibit or prevent the transmission to the brain of the knowledge of the injury

4 Pressure over any bony eminence injured, or pressure applied upon the zones corresponding to the location of the injury will tend to relieve pain. Not only will it relieve pain but if the pressure is strong enough and long enough and in the right place it will frequently produce analgesia, or insensibility to pain.

These are some of the many ailments that Fitzgerald said he treated:

Abdominal pains

Abortion (prevention of)

Angina pectoris

Arm problems



Bladder problems

Blood pressure disorders

Brachial neuritis

Breast problems


Cancer (he never claimed to cure)








Eustachian tube problems

Eye problems

Falling hair

Foot problems

Gall bladder problems



Hay fever


Heart problems




Intestinal problems

Labour pain


Liver problems

Locomotor ataxia

Loss of voice


Lung problems



Morning sickness


Nasal catarrh



Ovarian problems







Sea sickness


Sore throat

Testes problems

Throat problems






Uterine problems

Whooping cough

Zone therapy and acupuncture points

Fitzgerald never clarified where he became acquainted with the theory of zone therapy. He only spoke about how he stumbled upon the concept of zone therapy, and never ever mentioned whether there was any Oriental connection. Many of his reflex areas do correlate with acupuncture points, however.

For example, he spoke of Signor Umberto Sorrentino, a noted tenor, relieving his tight throat by squeezing the lateral aspect of the forefinger and thumb; these are acupoints governing the vocal chords. He also spoke of digging the fingernails into the inner side of the thumb. There is another well-known acupoint at the base of the thumbnail known as Lung 11 (abbreviated to LU-11) and it is effective for any throat problems or shortness of breath.

Fitzgerald also stated that scratching stimulates, deep pressure relaxes and that this knowledge should help many stomach problems. Morning sickness in pregnancy responded to deep pressure on backs of hands or the palmar surface of wrist and forearms. There is an acupoint on the inner forearm just below the wrist, Pericardium 6 (PE-6), used for nausea including motion sickness (utilized commercially in ‘Sea-Band’ wristbands).

In his chapter on painless childbirth, Fitzgerald spoke of pressures applied to the foot to alleviate pain and to enhance advancement of labour. He related how when contractions began and the mother started to feel discomfort, he would press on the foot with the thumbs of both hands at the metatarsal phalangeal joint for 3 minutes each time, and this greatly relieved the pain for the mother-to-be. On the great toe on the medial edge at the base of the nail bed there is a well-used acupoint, Spleen 1 (SP-1); this point relieves spasm in the uterus. On the lateral edge there are two points, Liver 1 (LIV-1) at the base of the nail bed and Liver 2 (LIV-2) on the metatarsal phalangeal joint; both points are helpful for problems of the genitourinary tract. (All of these points can be located by reference to figure 5.41 and 6.8a and b.)

For any pain in the head Fitzgerald suggested using pressure on the middle or tips of the fingers and toes, holding this pressure for up to 3 minutes. On the toes and fingers are several acupoints that help the head area. The tips of the toes are known as ‘Qiduan’; the tips of the fingers are known as ‘Shixuan’, and both benefit the whole nervous system. On the dorsal surface of the foot are the following acupoints: SP-1, the first point on the great toe, and LIV-1, on the lateral edge of the great toe, both help to calm the mind; Gall Bladder 44 (GB-44), on the lateral edge of the fourth toe, relieves headaches and also helps eyes and ears; Bladder 67 (BL-67) alleviates headaches. On the hands, starting from the index finger, all meridians arise on the dorsal surface at the base of the nail. First Large Intestine 1 (LI-1), on the medial edge of the index finger, calms the mind, is for any anxiety, and will also restore consciousness; Pericardium 9 (PE-9), on the medial edge of the middle finger, helps calm the mind when anxious; Triple Burner 1 (TB-1) on the lateral edge of the ring finger, aids all ear problems and painful stiff shoulders; Heart 9 (HE-9), on the medial edge of the little finger, is a marvellous point for headaches; the Small Intestine (SI-1) meridian also arises on the little finger, but on the lateral edge, and points on this benefit headaches and stiff neck. For detailed maps of the meridian pathways see figures 2.82.20.) Did Fitzgerald know of the existence of these acupoints, or was his knowledge obtained solely from observations? It is interesting that all the three Yang meridians of the upper body run to the face and pass their energy to the descending three Yang meridians of the lower body. These Yang meridians could be seen as three continuous channels, from hands to face, face to foot, or vice versa. The three Yin meridians could also be seen as three continuous channels from foot to breast, breast to hands or hands to breast, and breast to foot. According to the philosophy of the meridians, these are accessible on both sides of the body, so we would see six channels almost running longitudinally, being accessible on either the feet or the hands (figure 1.13). Fitzgerald possibly saw this connection as the meridians merging in the body, and this encouraged him to experiment with his zonal theory. (Remember his comment: ‘Five lines there marked out. I have designed these figures in this manner purposely to avoid making six lines, which would be confusing to the student.’) This seems to be a simplified version incorporating all the meridians. So regardless of how he gained his insight he did produce a simplified version of the meridian theory.

We can also compare the practices derived from the meridian theory with those of the reflexology theory. For instance, in the latter in many cases the feet are found to be far more energetic and forceful in the outcome of treatment, while the hands still being potent but with less chance of creating too much movement of energy within the body; hence they must always be the first area to work on in anyone who is seriously ill, or the very young or elderly. This is understandable by reference to the interchange of Yin and Yang energy believed to occur on the hands and feet.

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Figure 1.13 Merging of the meridians, making six lines of energy either side of the medial line

The statements by Fitzgerald that all zones must be free from irritation and obstruction, and that pressure could be given with rubber bands, pegs or clamps on any bony prominence, are of interest. The meridians in TCM are believed to lie alongside the bones, often following neural pathways. Fitzgerald expounded that pressure stimulated certain control centres in the medulla oblongata, or even functions carried out by the pituitary body and its many nerve pathways. The connection between nerve function, reflexology and acupuncture is discussed in detail in chapter 2.

Reflexology after Dr Fitzgerald

Dr William H Fitzgerald (1872–1942) was one of the most forward-thinking of medical men who became a natural healer through the art of using a pressure therapy to benefit and heal the human body. Many colleagues who assisted him throughout those early years of discovering the art of zone therapy went on to elaborate these techniques. This was based on the idea that the body was marked off with imaginary lines running from digits on the feet to the digits on the hands, each line passing through an organ. Pressure was applied on a given point and caused a reflex action; this led to normalization of muscle fibres in the corresponding organ within that zone, or stimulated the interrelated muscle to relax. The theory was based on observations over a period of people who were in discomfort; if they hurt themselves they rubbed the offending part. If they expected pain they would clench their fists or hold on tight to a chair. The hypothesis was developed that if the correct action were adopted then relief from pain would ensue and discomfort could be eased. The pressure was not just a nerve block with an analgesic effect or loss of sensation in that zone, rather that if the right pressures were used on the correct points the problem or disorder the person was suffering from could be alleviated.

From 1913 to about 1920 most work on zone therapy was being developed by two other medical physicians, Doctors Bowers and White. Edwin F Bowers MD, a well-known medical critic and writer, wrote an article on Dr Fitzgerald’s work. The method was unnamed at the time so he christened it ‘zone therapy’. He further elaborated that ‘Man was admittedly of chemical formation controlled by electrical energy, or electronic vibration’ introducing the concept of energy to the system. Dr Fitzgerald also taught George Starr White MD, who acknowledged in his writings A Lecture Course to Physicians (seventh edition revised) that credit must be given to Dr Fitzgerald for the discovery of mapping out the body into five zones each side of the medial line. He also stated that others had used a form of pressure for the relief of pain but prior to this there was no system regarding its use. He also said ‘“Zone Therapy” must be classed with the best and most original procedure in medicine today.’ Further, he quoted Dr Fitzgerald’s statement that, ‘Zone therapy is not a cure-all, but it is a valuable adjunct in therapy.’

It was during this time that William Fitzgerald lectured to Dr Joe Shelby-Riley and his wife Elizabeth Ann Riley. They had a school of chiropractic in Washington DC. Fitzgerald found that naturopaths, chiropractors and osteopaths were willing converts as they were interested in any drugless therapy. Dr Shelby-Riley became more than just interested in zone therapy during his lifetime; he also wrote 12 books, his first Zone Therapy Simplified (written in 1919) was mentioned in his later work Science and Practice of Chiropractic with Allied Sciences (1925). A later book was just entitled Zone Reflex; the 12th edition was copyrighted in 1942. By then the Rileys had elaborated and greatly broadened their instructions and introduced a technique called hook-work in which the fingers are hooked under bones (e.g. the scapula) in connection with zone therapy. Elizabeth Ann Riley was a remarkable teacher of zone therapy.

In 1919 a young man named Harry Bond Bressler graduated from the Shelby-Rileys’ chiropractic school, receiving a Degree of Chiropractic, and joined Dr Shelby-Riley in his practice in 1920. He wrote a book in 1955, confirming everything that had previously been written by Fitzgerald. Bressler considered that Fitzgerald had become acquainted with the art of pressure therapy in Vienna, which was very possible because many doctors and naturopaths visited the continent for seminars and meetings. Note that both in this book and in subsequent books written, some anomalies regarding reflexology points arose. Bressler made an issue of the terminology to be used when referring to the digits, because he felt that some people were confused. He called the first phalanx or finger joint the proximal phalanx (nearest the palm), the next was the middle or second phalanx, and the one nearest the end of the finger was the distal or third phalanx (with exception of the thumb and great toe, which have only two phalanges, a proximal and a distal). He clearly stated that the eyes related to the tips of the index finger and second toe, being the third or end joint (he said to try the third or middle digits). For the ears he said he used the fourth finger, the ring finger (note that the ring finger is actually the third finger); the third finger in TCM contains the Triple Burner meridian and is always used for ear problems. Fitzgerald had specified raising the nail on the third finger for tinnitus of the ear; however, Bressler wrote that he had confirmed Fitzgerald’s work of raising the lateral edge of the nail of the fourth finger for ear noises for 2–5 minutes, three or four times each day. Harry Bond Bressler also linked ear problems to the liver; I think this was because the Gall Bladder channel commences on the face and contours the ear to terminate in the fourth toe. The toe terminal point is also used for ear problems, as because many of the disorders linked to the Gall Bladder meridian are often high congested states the liver would definitely also be out of balance. In his chapter on ears he also included ear massage, but his points do not relate to the known acupoints.

Reading through Fitzgerald’s book you are made aware that, even though he worked on the actual organ involved, often he was also looking for other organs that might be contributing to the condition. That is, he was looking for ‘areas of assistance’ or associated areas, one of the basic concepts of reflexology today. For instance, not only did he refer to ingrowing toenails contributing to headaches but he stated that this would affect the entire zone and could be the contributing factor for a discordant condition expressed in a distant organ within that area. Undue pressures would cause a problem within any part of that zone.

Bressler’s one main deviation appeared in his depiction of the zones. Fitzgerald’s early work had always depicted the zones as ten lines of energy, five each side of the medial line, and his diagrams clearly show this (see figure 1.10). The five lines are quite clearly marked out, and each line represents the centre of that respective zone. Fitzgerald clearly stated that he designed these figures in this way to avoid confusion. However, Harry Bond Bressler states that the zones commence in the web of the first phalange; this results in only four lines either side of the median line, which is not as Fitzgerald’s original concept. It is important to be aware of this alteration.

Eunice Ingham, another author, was also a student of the Riley chiropractic school. In her book she stated that Dr Fitzgerald, in his work Zone Therapy, blazed the path for further developments, as he ‘brings to light for our consideration his discovery of the ten various zones of the body and location of each organ in the body in one or more of these zones’. If the feet and the hands are supposed to represent the physical body with all organs laid out in a similar arrangement, every book or chart should be the same, with variations only being in the format. However, in Ingham’s books the eye and ear reflexes are clearly depicted at the base of toes two, three and four and this arrangement has been followed in many later books. Was this due to the fact that the acupoint just before the terminal point on the Stomach meridian (see figure 5.41) is at the metatarsal phalange at the base of the second toe, a point that is used for all facial problems? Similarly, on the fourth toe the last but one point on the Gall Bladder meridian (GB-43) is for all ear and eye problems (see figure 5.41). Ingham also shows the Heart area covering the same area as that of the Lungs, and suggests working on the shoulder reflex under the fourth and fifth toes, which correspond to the fourth and fifth zones. In TCM the Heart meridian is on the fifth finger, so we should be able to access the heart through the zone. Ingham states ‘take any of the internal organs of the body and determine what zone line passes through them’. This system will guide you in reflexology as we know it today. Ingham stated that the zone concept had become a powerful and important tool in the relief of many disorders and that zone therapy had the ability to stimulate the body’s own natural healing process and allow it to balance its own natural energies. A balanced energy flow should have no blockages.

Doreen E Bayly was trained by Eunice Ingham in America and was responsible for bringing the therapy to Great Britain in 1966. Her book Healing through the Feet was published in 1978.

In the 1960s a young Yorkshire man named Joseph Corvo was taught the zone principle by one of Dr William Fitzgerald’s believers. Today he practises and teaches zone therapy, but does not link it with reflexology. He claimed the system is as old as the human race, that it is a natural instinct to put your hand on a painful part and press it, and that it not only relieves the effect but also removes the cause. He also maintained that you could not harm yourself in any way using the ‘zonery system’ and that it was absolutely safe. To date Joseph Corvo must be listed amongst the great masters for the vast amount of treatment that he has given to help so many and the many books that he has also written.

Regardless of what name we call this therapy by – the zonary system, zone therapy, reflex zones of the feet and hands, or just simply reflexology – there is no doubt it is an ever-expanding activity. As more details are discussed, explanations sought and more research is undertaken our knowledge will expand greatly. If William Fitzgerald was known as the ‘grandfather’ of the zone theory then Eunice Ingham is known as the ‘mother’ of contemporary reflexology. Regardless of how these forward-thinking people developed their theories, even if we do not exactly agree with them let us explore them all. Daily new theories and techniques are being developed worldwide but many of Fitzgerald’s and Ingham’s basic methods and procedures are still taught today.

Through the years we have also had many great naturopaths who believed in the wonderful art of natural self-healing for treating illness; their methods included changing the food that people eat and utilizing the forces of nature such as fresh clean air, light, heat, cold and water (which has been used therapeutically for thousands of years). These drugless methods also incorporated physical exercises and massage.

Important events in the development of reflexology

This calendar in Box 1.1 outlines some important medical events from ancient history to the present day, showing how it may appertain to the whole theory of reflexology, and how the West and the East have something in common with this incredible therapy.

Box 1.1 Important Events in the Development of Reflexology

C2500 BC China – Beginnings of acupuncture in China

C2330 BC Egypt – Tomb of Ankhmahor built depicting representations of surgical operations, or treatment of hands and feet

C1558 BC China – Acupuncture in China became more refined

C500 BC Japan – Acupuncture reached Japan

AD 420 China – A bronze statue was cast showing the location of all the points of acupuncture

1582 Europe – First book of zone therapy published by Doctors Adamus and A’tatis

1776 Per Henrick Ling was noted for his gymnastics; lingism, as it was later known, was the treatment of disease with both active and passive moves

1800s Britain – Treatment by acupuncture was introduced into Britain and the term ‘reflex’ used by many medical men

Early 1800s Japan – Reiki, an ancient energy healing system based on very old Tibetan texts, arose from the teachings of Dr Mikao Usui; its theory was that the universal life energy was channelled through to the practitioner, who in turn conveyed it through the fingertips to those who needed it

1823 Britain – First issue of the Lancet was printed. A case of acupuncture treatment was reported. Successful treatment was carried out by a Dr Tweedale of Lyme Regis

1827 Britain – Acupuncture was used in the Royal Infirmary, Edinburgh and St Thomas’s Hospital, London

Early 1800s Italy – Filippo Pacini (1812–83), an anatomist, discovered Pacinian corpuscles: sensory receptors in the skin particularly sensitive to changes of pressure, also found in joints and tendons. Angelo Ruffini (1864–1929), an anatomist, discovered Ruffini corpuscles, which record dermal distortions; they are cylindrical sensory organs that respond to pressure and warmth, found in finger pads, joints, tendons and tendon sheaths

Early 1800s Germany – Johannes Peter Müller (1801–58), a physiologist, proposed the principle of the law of specific irritability, the principle that each nerve is excited via sense organs responsive to a specific form of energy, and its excitation, because of its connections, can give rise to only one modality of sensation, regardless of whether the nerve is electrically or mechanically excited. Karl Ludwig Merkel (1812–76), an anatomist, discovered Merkel’s discs, tactile end-organs; these are slow-acting mechanoreceptors, responding when the tissue is stretched. George Meissner (1829–1905), a histologist, discovered Meissner’s plexus, a fine network of nerves in the wall of the alimentary canal, also Meissner’s corpuscles, found in the fingertips and lips

1880 Europe – Acupuncture was used in Europe. The connection could be the French Consul in China, Soulie de Morant, who became closely associated with Chinese philosophy. He studied the Chinese language and many ancient treatises on the subject. Many of them were thousands of years old and he translated them into French

Late 1800s Europe – From the latter part of the 1800s great strides were made by the medical profession in the study of reflexes. Many devices were used to deliver electrical stimuli to parts of the body. These were to establish the identity of nerves, such as whether they were sensory or motor. They also established, by the response raised, if a nerve or tract was damaged or absent. As these responsive actions indicate externally what is taking place within the body, it is my belief that we can send a message in on the same pathway

Late 1800s Germany – Mendel-Bekhterev reflex abnormal response was found showing dysfunction in the corticospinal tract; Kurt Mendel (1874–1946) was a neurologist. Hermann Oppenheim (1858–1936), a neurologist, found that when pressure is applied on the tibial crest there is a fanning of all the toes and an extension of the great toe. This is indicative of lesions within the pyramidal tract

Late 1800s USA – Charles Gilbert Chaddock (1861–1936), a neurologist, found that reflex extension of the great toe was induced by percussion on the external malleolar region and this was indicative of pyramidal tract lesion. Alfred Gordon (1874–1953), a neurologist, found the knee jerk reflex and extensor plantar response evident in pyramidal tract disease; this was produced when squeezing the calf muscles

1886 Russia – Vladimir Michailovich Bekhterev (1857–1927) led historical development in experimental methods of reflexology on animals and then the study of human behaviour

1886–7 Russia – Ivan Petrovich Pavlov (1849–1936), a physiologist, studied conditioned reflex activity in dogs and received the Nobel Prize in 1904 by proving that there was a direct association between a stimulus and a response reflex action (see chapter 2)

Late 1800s Russia – Lyudvig Martinovitch Puussepp (1875–1942), a neurosurgeon, discovered that there is a slow abduction of the little toe in response to stroking the outer aspect of the foot, which is indicative of upper motor neuron disease. These abnormal reflexes are not present in healthy individuals

1892 France – Dr Joseph François Felix Babinski (1857–1932), a neurologist, ascertained the plantar reflex (see chapter 2, page 46)

1893 England – Sir Henry Head (1861–1940), a neurologist, published research proving a direct relationship between pressure applied to the skin and its effect on internal organs. This was later clarified to be the effects of dermatomes (see chapter 2, page 43)

1895 United States – Dr William Fitzgerald (1872–1942) qualified at the University of Vermont, and was the originator of the theory of zone therapy (died 21 October 1942 in Stamford, Connecticut)

1897 Egypt – Tomb of Ankhmahor at Saqqara discovered by V Loret depicting treatment of feet, hands and legs

1902 Vienna – Fitzgerald studied and taught in Vienna

1906 England – Sir Charles Scott Sherrington (1859–1952), an Oxford physiologist, proved that the whole nervous system responded to stimuli from proprioceptors, specialized sensory nerve endings that monitored internal changes in the body. He published his findings in The Integrative Action of the Nervous System

1907 Russia – Bekhterev formed the Psychoneurological Institute, and later became the Director of the State Reflexological Institute for the study of the brain in Leningrad

1913–20 Washington – Fitzgerald went to Washington to teach and lecture to Shelby-Riley students

1915 United States – Edwin Bowers article published ‘To stop that toothache squeeze your toe’

1917 United States – Edwin Bowers MD and William Fitzgerald MD published Zone Therapy. Many other books were published during this period

1919 United States – Dr Joe Shelby-Riley published first of 12 books about zone therapy, the last being published in 1942

1928 Russia – Bekhterev had his work translated into English

1938 United States – Eunice Ingham (24 February 1889–10 December 1974) published Stories the Feet Can Tell

1945 United States – Eunice Ingham published Stories the Feet Have Told

1949 United States – Dr Roy S Ashton published The Fundamental System Bad Feet-Bad Spine showing the connection between foot abnormalities and the spine

1955 United States – Harry Bond Bressler published his book Zone Therapy confirming all of Dr William Fitzgerald’s work

1966 England – Doreen Bayly returned from America after training with Eunice Ingham and introduced reflexology to Britain; she published her first foot chart in black and white in 1966 entitled ‘The Eunice Ingham method chart produced by Doreen Bayly’

1974 Germany – Hanne Marquardt studied with Ingham in 1970; then she published Reflex Zone Therapy of the Feet

1978 England – Reflexology Today. The Stimulation of The Body’s Healing Forces Through Foot Massage was published by Doreen Bayly. Her earlier chart was reproduced in colour in 1970

1978 Taiwan – Father Joseph Eugster began his dedicated work, teaching reflexology

1980s England – Complementary medicine and reflexology specifically became a growth area; by this time over 80 books had now been written, and many articles, some with conflicting points but many stating a similar theme. Societies and associations were formed from 1983 onwards around the world. Schools were set up with many offering short training programmes leading to a certificate to practise

1990s England – Directories were set up but are not conclusive, as many people do not choose to advertise this way. The Institute for Complementary Medicine formed a British Register of Complementary Practitioners (BRCP). The British Council of Complementary Medicine is a registered charity, which was formed to establish national standards in all developing areas of complementary medicine. It works in tandem with the BRCP. The British Complementary Medicine Association (BCMA) was formed in 1992 to assist therapists in the setting of standards of practice and to encourage them to join together in self-regulatory bodies. The BCMA is a leading member of the Independent Care Organisations (ICO) – the body charged with setting standards in private health care.

Research programmes are being initiated. The years ahead look promising.

2 A holistic approach to medicine

The concept of holistic medicine

Holistic medicine is an approach to health care in general; it is based upon the idea that health is the result of harmony between the body, mind and spirit and any extreme stress of any kind, which includes physical, psychological, social and environmental pressure, is inimical to good health.

Natural healing takes place every day. When you cut yourself, the body’s innate power draws and knits together tissue and heals the wound. If we fracture a bone, many parts of the body perform different tasks for healing to occur; a team effort is needed, as no single body part works alone. The body is like a machine with many component parts that perform daily chores in maintaining blood circulation, and ensuring the correct level of fluids and enzymes to keep it in good running order. These functions would not be able to take place without energy. Food is the fuel that provides the energy the body needs for its cells to perform their intricate tasks. Every part of the body is involved with a complex nerve network, with the brain as the control centre, monitoring and co-ordinating every function. All the component parts need to be in balance.

Reflexology provides the means whereby the body can be synchronized to balance the timing of its engine. Reflexology is a fascinating study of the links between reflex points of the feet and hands and longitudinal (vertical) pathways or zones. As we work on the feet, we thus form a picture of the entire body. In this way the feet or hands are considered a microcosm of the body, with all organs, glands, and so on laid out in the same arrangement (for details of the reflex areas, see plates 1–4).

As mentioned above, all processes that take place in the cells of the body need energy. The energy transfer that is central to reflexology and other healing systems such as shiatsu, acupuncture and acupressure allows the body’s integrated systems to achieve homeostasis. We often hear in traditional medical systems terms such as ‘Chi’, frequently translated as ‘life energy’ or ‘life force’, or ‘Prana’, meaning breath of life. Energy is indeed constantly circulating through the body and is the very foundation of life. At a cellular level, we need energy to survive, we draw energy from the food we eat and this powers every cell within the body, which in turn needs its own energy to function. It is this much deeper level of biotic energy, the innate energy at cellular level, which maintains the metabolic processes that we work on.

At the neurological level, every machine needs a control system, and the complex brain is the control and computer system of the body. The brain, which is the source of conscious awareness of each and every thought process, is also a motor centre initiating and co-ordinating the voluntary movements of the body, and interpreting all the fast incoming information received from the sense organs. It monitors and discharges the necessary signals to muscles, glands or other parts of the nervous system to respond appropriately. It is a vast network, and is the body’s greatest user of energy, to power the many chemical and neurological processes associated with it.

The physical body and its component parts are made up from billions and billions of cells, and even though there are many types, shapes and sizes, the one thing they all have in common is a requirement for energy. According to the holistic concept, for instance as found in TCM theory, if this internal energy is obstructed, deficient or in excess in any way the cells function less effectively. In reflexology, during a treatment session the therapist will utilize those pathways of energy that already exist in the human body and they return the imbalanced or deficient energy flow safely back into harmony. Reflexology treatment is given to look after and nurture the body, and is often likened to the constant maintenance and preservation that a machine needs to keep it in good running order. We know for any effective control of any manmade apparatus it needs power or energy and maintenance. The first often can only be achieved by giving it a motor or engine that drives it, and this in turn must be maintained. The engine may be driven or powered by electricity or another substance.

Two opposing systems are also usually needed to make it work, for instance in a car engine the brake and the accelerator. This again is paralleled in many of the systems within the body. Locomotion is the result of the co-ordinated action of muscles on the limbs. The muscles of the body work in antagonizing pairs. The same is true of hormones which interact in a biofeedback system that enables them to regulate the body towards an almost constant state. For example, glucagon raises the level of blood glucose, while insulin has an opposing effect and lowers the glucose levels. High levels of oestrogen are secreted by the ovaries to stimulate ovulation but (in the absence of egg fertilization) are counterbalanced during the monthly menstrual cycle by progesterone, which in turn is only secreted under the control of other hormones from the pituitary. These gonadotrophin hormones thus work in unison. From this we see how the body must be in balance. Hormones are responsible for certain changes in the body, and work together with the nervous system to monitor and control blood pressure levels. Hormone responses are not so quick as those of the nervous system, and they function more on a long-term basis. By these physiological processes all the internal systems of the body (for example blood pressure, body temperature, the acid-base balance) are maintained at equilibrium despite variations in the external conditions. If there is a homeostatic imbalance in the various systems then disease will eventually occur.

Since all the systems of the body interrelate, only one area needs to be slightly out of balance to lead to disorders in other areas. These problems can often be observed to travel up and down a zone and even affect other parts of the body. Ill-health often falls into what is known as the ‘vague symptom’ category: a general malaise is often felt, every part of the body aches with general stress in neck and shoulders, the person may be irritable, not sleeping properly, picking at or eating too much food, making them feel ill or tense. Such a person may be unsure whether to go to their doctor or not, in case they are labelled neurotic, and the symptoms often continue for a long period of time. It is only when a problem becomes chronic do they begin to be more concerned.

Many complementary therapies, among them reflexology, are natural, non-invasive, and drugless paths to self-help, helping to restore a person to a more tranquil temperament, improve their mental condition and enable the person to cope better with life’s demands. Reflexology treatment encourages a generally healthier body by facilitating the proper functioning of the circulatory system, so enabling the supply of nutrients and oxygen to reach all cells of the body.

Imbalance of our internal environment is often caused by stress (see chapter 10 for a detailed discussion of this). The excitatory process of a stress stimulus often changes this internal environment, causing high blood pressure, pain in many parts of the body because the muscles become tense, depression, brooding or morbid thoughts, a change in our circadian (or daily) rhythms and other regular biological body rhythms (e.g. daily body temperature variations, sleeping and waking patterns, the female menstrual cycle). The hypothalamus and the medulla oblongata (see figure 2.23) contain the main brain centres controlling such homeostatic functions. While in a healthy body slight changes can be coped with, major changes such as going on holiday abroad (time change) can cause a very real problem. Also shift workers, for instance nurses or people who work nights, often find this interference with regular rhythms of the body leads to the so-called psychosomatic disorders (i.e. mental and physical disorders such as asthma, eczema, peptic ulcer, irritable bowel syndrome, headaches, back stresses). All these are caused by the body’s automatic responses to stress, mediated by the autonomic nervous system.

Theories and philosophies

What is energy?

The general definition of energy is ‘power’, ‘vigour’, ‘vitality’ or ‘force’; in physics the definition of energy is the work that a physical system is capable of doing. Energy cannot be destroyed but it can change form. The body’s processes utilize electrical and chemical forms of energy. Kirlian photography is a special form of high-voltage photographic process which apparently records the energy field around the body on light-sensitive paper. This process has demonstrated changes in the energy field before and after a reflexology treatment. The exact nature of this energy field is a matter of debate. Eastern and Western systems have tended to have different views on this.

Reflexology is a method of contacting the electrical centres in the body. It aims to create a smooth flow of ‘vibratory energy’ throughout the body. By contacting various points on the feet this energy is thought to travel to the spine and then out to the organs, glands or cells, following set paths, although these are thought not to correspond to the Chinese meridians. However, the nature of the energy is thought to be the same.

Polarity therapy is another therapy based on the Yin and Yang principles (see chapter 1). Its theory is that life energy flows between the two poles, one positive flowing to a negative pole and vice versa. This concept was applied by Doctor Randolph Stone to the general condition of the human body and mind. He likened the movement of energy in the human body as energetic currents; he referred to this as the ‘wireless anatomy of man’. The ancient Chinese looked at the living body as being one of the expressions of tension between two poles, heaven and earth. Heaven is found above the head, the Creative, awakening our higher nature, our source of ideas. Earth lies beneath the feet, the Receptive. The head and feet, and the hands, can be viewed as mediators channelling Qi energy to various organs or glands that need revitalizing.

The body field can be demonstrated by the following exercise. With your palms facing, rub your hands together quite gently, then move your hands very slowly a few inches apart, you should feel a sensation of warmth, or flow, or a magnetic type of pulling sensation in the fingers between the two hands.

Reflexology aims to stabilize elements lacking or unbalanced in a person’s basic energy; the touch of the practitioner’s hand on a person’s feet can also be thought to create a flow of energy between them. This particular technique of touch has a great ability to calm down and completely relax a person.

In reflexology the distribution of energy in the whole body is considered to correspond to the distribution of energy in the hands and feet. So by holding a person’s hand or foot you become very aware of their internal structure: the limbs, bones, joints, muscles, arteries, nerves, skin and nails. You also begin to feel you can ‘read’ the energy structure within.

Life energy can mean many different things to people working in different traditions. Perhaps we should not try to explain it, but be satisfied with being aware of its existence. We should also keep in mind that we not only touch tissue, muscle and bone but we also ‘touch’ the very life force of the body.

How the nervous system works


We know that any part of the skin is sensitive to touch. Touch has been used therapeutically over thousands of years. The skin is also very responsive to heat, pain and pressure, whether by touch or by other means. Even pressure from air or water brings about a responsive action in the physical body. Each and every area of the body is connected to the incredible nerve network within the brain that acts like an overseer, guiding and supervising as well as modifying the output when necessary.

Study of the body’s anatomy and physiology tells us how these nerve signals are transmitted from the specialized sensory receptors and how they respond to different stimuli. Sense organs are groups of cells that are connected to the brain or spinal cord by nerve fibres (or neurons) running along particular pathways. Those sensory nerve messages originating from the hands and the feet are received in a relatively large area in the brain’s sensory cortex compared with those from other locations, showing the innumerable nerve endings that we have in these areas. An anatomical figure (figure 2.1) depicting the size of the sensory areas in one of the paired, halves of the cerebrum that contains the sensory cortex and associated areas shows how tactile the hands and feet are. The fingertips and toes are particularly susceptible to touch because the tactile receptors called Meissner’s corpuscles are in abundance in the uppermost part of the dermis in this area of non-hairy skin. The free nerve endings found in most parts of the body enable sensations of pain, touch, pressure and temperature also to be relayed to the brain. Even hair plexuses respond to pain and touch, while Pacinian corpuscles in the dermis immediately respond to pressure and send their messages to the sensory cortex of the brain.

image 14

Figure 2.1 Anatomical figure depicting the large sensory area the hands and feet occupy in the brain

If there is a stimulus to any of the simple receptors, including all the touch, pain or pressure receptors, this sets off an electrical impulse; a strong stimulus will produce a stronger sensation – for instance, we know how a headache can develop very quickly when we stub our toe. Pain receptors in the skin are known as nociceptors: these include many of the free nerve endings found in the tissues.

The sensory nerve endings lie in the corium, the true skin; they are found within the tiny projections of this deeper layer. Each nerve fibre enters a small rounded bulb. These Pacinian corpuscles, responding to deep pressure, are abundant in the palmar surface of the hands and the plantar surface of the feet, and in all the digits, also around the tendons and ligaments. The smaller corpuscles, the tactile corpuscles of Meissner, are richly abundant in the pads of the fingertips and toes and also in the palms of the hands and soles of the feet; these are in the papillae of the skin.

Every time we stretch the tissue or muscles we contact the group of cells called the mechanoreceptors, found in the basal epidermis, in the form of Merkel’s discs. They adapt very slowly to stimulation and they trigger impulses in the sensory nervous system. The reflex action helps to adjust the tone of muscles and the activity of the internal organs. (The isometric exercises carried out during a reflexology treatment session involve active voluntary contraction of muscles without producing movement of a joint. There is also a passive exercise known as neuromuscular facilitation, used to enhance contraction or relaxation of muscles.)

Nerve transmission

In the very simplest of reflexes a sensory neurone on the skin’s surface, when palpated or pressed, will react by sending a signal along the nerve fibre belonging to it; this signal will pass to the central nervous system (see here); once at its terminal end it will connect with another nerve cell, which in turn is also stimulated. The action within this second cell is enough to cause a muscle to contract or to even increase the secretory function of a gland (figure 2.2).

A nerve signal is an electrical impulse produced by chemical reactions on the surface of the cell body of a neurone (a nerve cell). Nerve signals traverse the whole nervous system, both electrically and chemically. Electric signals or impulses are carried from one end of a nerve cell to the other end. However, to cross the gap (the synapse) between nerve cells, chemicals called neurotransmitters are released from the end of the cell in response to the electrical impulse. These chemicals move across the synapse and bind on to the receptor sites of the adjacent cells. This sets off another electrical impulse in the next neurone, and so on.

image 15

Figure 2.2 Transmission of nerve impulses

Afferent (sensory) fibres transmit impulses to the centre from the skin, muscles, bones and joints. (However, not all afferent action is consciously perceived.) Efferent (motor) neurons innervate muscle fibres, conveying messages from the brain or spinal cord to muscles, glands or other effector organs (figure 2.3).

When pain or another stimulus is detected the electrical signals are sent to the spinal cord and often ascend to the higher centres within the brain (figure 2.3). The areas in the brain then correlate the information, sending the information by way of the midbrain (a small portion of the brainstem) to the hindbrain, or medulla oblongata (see figure 2.23). These brain areas are involved in the co-ordination of sensory and motor impulses within the body. The returning neural impulse travels back down a motor nerve pathway to where the pain communication came from, when it may stimulate release of endorphins – natural opiates that are often referred to as ‘mood enhancers’. This may be why people often report a wonderful sense of well-being after a reflexology treatment. Stimulation of these touch or tactile corpuscles triggers a motor reaction. Consideration of an automatic reaction (such as the reaction when you receive a burn) shows how quickly the nervous system can react to stimuli.

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Figure 2.3 A section through the spinal cord, to show sensory and motor pathways

Normally when resting there is a relatively low level of electrical activity in the brain because it acts as a switchboard, receiving impulses from the many sensory organs of the body and correlating these various stimuli and interpreting them accordingly, sending off motor signals to supply a muscle or a gland into stimulation or relaxation, and so on (see figure 2.2). Reflexology may act as a stimulant, by increasing the rate of activity in an organ or system, or it may act as an energizer giving the person more vitality and zest. It is also evident after treatment that it has a calming influence, acting as a relaxant to such a degree that it enables the person to unwind and be totally rested and with muscles that are less stiff or tight.

Pain is a sensation we get when our sensory nerves are irritated or inflamed and injured. We all relieve our pain in a similar way when we rub the affected part or area that is hurting. This stimulates the firing of nerve fibres that inhibit the pain signal. This phenomenon was observed by Dr William Fitzgerald prior to his developing the ‘zone concept’. However, in reflexology the pressure treatment helps to relieve disorders themselves as well as just relieving pain. Because during treatment the patient is able to relax, the pain of a stiff neck or low back pain, or even abdominal discomfort, is able to just ebb away during the treatment. The medical profession often say any benefit is due to the placebo (or ‘expectation’) effect because the client has faith in the powers of the therapist or therapy; if that is so then that is in itself a marvellous phenomenon. However, I feel that its mechanism is far more profound than that. I have treated many sceptics who on the first visit state something like, ‘I am sure you will not be able to help me, but I have tried everything else, so I thought it would not hurt me if I came’, or ‘I only came because my wife suggested it, but I cannot see how fiddling with my hands, feet or ears is going to help my stiff knee’. These are just two examples of typical comments one may get from a sceptical person in the first instance. But even so if a good response is obtained such clients will virtually sing it from the rooftops. My most ardent supporter has recommended more patients to me than any other person to date, but at his first session he was almost disdainfully sceptical, and told me he had only attended at the request of his wife. Reflexology is now part of the lives of many such patients because they see it as a preventative against recurrence of ill-health.

Divisions of the nervous system

The nervous system is divided into a number of parts. First, there is the division into the central nervous system (the brain and spinal cord) and the peripheral nervous system. The peripheral nervous system distributes to the skin or peripheral parts of the body. The spinal nerves emerge from the spinal cord; the cranial nerves emerge directly from the brain. (See figure 2.5.) There is a functional division between the somatic nervous system, supplying the skeletal muscles, and the autonomic nervous system, supplying the glands, cardiac muscle, and smooth muscle of the internal organs. Reflexology contacts the autonomic nervous system, more than any other therapy, balancing the parasympathetic nervous system and the sympathetic nervous system. These are the two subdivisions of the autonomic nervous system. They exert opposite effects on the end organs, so that homeostasis is maintained. Sympathetic impulses tend to stimulate, and parasympathetic impulses inhibit; for instance, the first increase the heart rate, while the second slow it down. (See figures 2.4 and 2.5)

The spinal cord gives off 31 pairs of nerves in its course from the base of the skull to the lumbar region, each of these nerves arises by two roots, an anterior and a posterior root, one being sensory, the other being motor; these unite prior to leaving the spinal canal, forming a mixed nerve that then separates, supplying the front and back of the body respectively. The nerves that form plexuses are from the top and the bottom of the spinal cord; out of these plexuses a number of branches arise to supply the arms and legs with a network of sensory and motor nerve fibres. These are the cervical, brachial, lumbar and sacral plexuses; the thoracic nerves from T2 do not form plexuses, but supply the skin and muscles in the corresponding area. The eight cervical nerves are divided into two. First there is the cervical plexus, formed from the upper four nerves (1–4); these also communicate with cranial nerves X, XI and XII. They have cutaneous sensory branches and penetrating muscular branches. The lower four (5–8) unite with the first dorsal nerves to form the brachial plexus.

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Figure 2.4 Functions of the autonomic nervous system

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Figure 2.5 Sympathetic and parasympathetic innervation of the spinal cord

The cranial nerves include the vagus nerve, which contains parasympathetic fibres that help the function of the viscera of the thorax and abdomen, motor nerve fibres to the muscles of larynx, sensory or somatic stimuli to the auditory canal, and also sensory (visceral afferent) stimuli of the thorax and abdomen. These cranial nerves comprise some motor nerves and some mixed nerves. There is also the trigeminal nerve, which has three branches; the ophthalmic nerve, passing through the superior orbital fissure (affecting the areas around the orbits and certain parts of the nasal cavities), the maxillary branch (affecting sensation below the orbits down to the upper jaw and teeth) and the mandibular nerve (again sensory to lower part of face, lower jaw and teeth, and the motor nucleus of this nerve serving the muscles of mastication). These nerves are attached to the brain stem at different levels. The major nerves all originate from nuclei inside the brain.

Note. It is important that the practitioner is aware of the cranial nerves at all times. There is a simple way of remembering these. I think of a very dear friend of mine from the early days – this lady’s name was OOOTTA FAGVSH. The letters of this name correspond to all the cranial nerves. The cranial nerves are given roman numerals, I—XII. We only have three sensory nerves (S), five motor (M), and four mixed (MX) both sensory and motor. Of these cranial nerves, four are parasympathetic nerves (P/S/N) – these are nerves III, VII, IX and X. The nerves are as follows:

I Olfaction – the sense of smell (S)
II Optic – the sense of vision (S)
III Oculomotor – the muscles of the eye (M. P/S/N)
IV Trochlear – the muscles of the eye (M)
V Trigeminal – the forehead, cheek sensations, and lower jaw (MX)
VI Abducent – the muscles of the eye (M)
VII Facial – impulses of taste and facial expression (MX. P/S/N)
VIII Auditory – the sense of hearing (S)
IX Glossopharyngeal – sensations from the tongue and to the pharynx (MX. P/S/N)
X Vagus – the larynx, trachea, oesophagus, heart, respiratory, all digestive organs, the small intestine, spleen, ascending colon, kidneys and the blood vessels (MX. P/S/N)
XI Spinal accessory – the muscles of the neck, the sternocleidomastoid and trapezius muscles (M)
XII Hypoglossal – the hyoid region and the muscles of the tongue (M).

By remembering the above name you will always ensure you never miss out on a brain region as it is so important.

The functioning of the autonomic nervous system is closely linked to the pituitary, the adrenal gland and many other specialized nerve cells that secrete their hormones at the nerve endings. Our sensory system makes us aware of changes; these elaborate sense organs receive stimuli from outside of our body. These are then transmitted to our brain. An enormous amount of information is fed into our nervous system; all this sensory information allows the organism to change and correct the internal environment. Interpretation by the brain depends on the connections through the many nerve pathways. If these connections are not co-ordinated the parts of our body fail to respond.

The autonomic nervous system (see figure 2.4) depends on the co-ordinated and opposing regulatory functions of the sympathetic and parasympathetic divisions of the nervous system. Each of the organs of the body is supplied with a dual set of nerves from each of these branches; the overall commander of the autonomic nervous system is the hypothalamus, which ensures the interdependence and co-ordination of functions within this system. We do not need to think consciously of which branch of the autonomic nervous system we need to stimulate during treatment, because the brain centre decides which section of it will be dominant when the system is stimulated. If the person is tired, lethargic or sluggish the sympathetic stimulation results in an improvement to all activities, with the person having more energy and sparkle. The body has remarkable powers to protect and heal itself. If the need is for the body to be calmed down, then the parasympathetic branch comes to the fore, slowing the heartbeat, inducing deep physical relaxation, promoting the digestion and increasing the tone and motility of the whole gastrointestinal tract and its eliminating process. If there is also a depletion or loss of energy, the parasympathetic division will help to conserve and restore the energy we need while we sleep. It is only when we are physically or emotionally stressed that the sympathetic nervous system may override the parasympathetic nervous system. This action may inhibit many functions, and the whole gastrointestinal tract may slow down, often decreasing motility and tone – hence the many digestive disorders that are evident in people who are extremely stressed.

The overseer of this dual innervation is the hypothalamus, which lies at the back of the forebrain in the floor of the third ventricle (see figure 2.23). This small portion of the brain controls the vital processes, acting as a regulatory centre of thirst, hunger and temperature, thus moderating the water and food intake. It also regulates the emotions and our sleep patterns and it governs the pituitary body, the major endocrine gland that releases many regulatory hormones directly into the bloodstream. If there is an imbalance in these hormones there can be a decline in the state of health. Ill-health can take many forms, from the simple headache to a complete breakdown in many of the functions of the body.

When the body is totally relaxed, its healing mechanism is given a chance to right itself as blood flow and nerve transmission are allowed to occur unimpeded. The benefits of reflexology are therefore manifold; all parts of the body can be reached through precise stimulation of the reflexes through the feet and hands. A return to homeostasis can be achieved after approximately 40 minutes of such stimulation.

The autonomic nervous system is not separate from the central nervous system; there are many interconnections. It was once thought that we have no control over the autonomic nervous system as most of its responses are involuntary. However, the Hindu system of yoga exercises appears to develop some degree of control and influence over it. Also the Chinese exercises of Tai Chi and Qigong (Chi Kung), popularly practised for health and relaxation, demonstrate that relaxation of the mind improves the natural flow of energy, which in turn stimulates all the internal organs. It seems that the health benefits are considerable when the body is relaxed, and many disorders benefit from the reduction of anxiety or stress.


Every area of skin is supplied by a spinal nerve, and each segment supplies a dermatome (figure 2.6), the deeper layers of the skin and its underlying connective tissue. Each individual dermatome is designated by the number of the spinal nerve root (cervical, dorsal, lumbar or sacral). If an area of skin is stimulated and there is no response, it is assumed that the nerve supplying the dermatome may be damaged.


There are also areas of division of the nerve supply of a bone, called sclerotomes. Each muscle fibre is served by at least one nerve fibre, which ends in a neuromuscular junction. (This is where the stimulus to contract is passed to; almost the meeting point of a nerve fibre and the muscle fibre that it supplies.)

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Figure 2.6 Dermatomes

Peripheral nerve innervation of a muscle is very closely followed by innervation of the appendicular skeleton. Any injury of these peripheral nerves may lead to fibrosis, a thickening or scarring of the connective tissue, most often as a result of injury or in the healing stage of inflammation. This often accounts for the referred areas of pain felt in the skin.


An essential part of the working of the nervous system is a group of chemicals known as neurotransmitters. There are excitatory and inhibitory neurotransmitters in the parasympathetic and sympathetic nervous systems. Excitatory transmitters stimulate action; inhibitory neurotransmitters inhibit it. When an impulse passes down a parasympathetic nerve, acetylcholine appears at nerve endings and then it transmits the effects of the parasympathetic impulse. This system is involved in maintaining normal levels of activity. The same happens with the sympathetic nervous system, which works in conjunction with the former. At the nerve endings the chemical noradrenaline (a hormone closely related to adrenaline) is released as a neurotransmitter by sympathetic nerve endings. Among its many actions are constriction of swollen blood vessels, often leading to an increase in blood pressure. Increasing the blood flow through the coronary arteries and slowing of the heart rate increases the rate and depth of breathing and complete relaxation to the smooth muscle of the intestinal walls.

Even today there is still a lot to learn about their different types and what each individual chemical does. Most nervous disorders are linked to the homeostatic imbalance of these substances. Many of the 50 or so neurotransmitters of the nervous system are thought to be neuromodulators; the largest group is known as the neuropeptides, which are thought to include both excitatory and inhibitory factors. One particular neuropeptide found within the sensory nerves, the spinal cord pathways and certain portions of the brain is known as substance P; it is thought to stimulate the perception of pain. It is also thought to be involved in the spinal cord pathways and certain portions of the brain that are associated in pain transmission. Conversely, it is known that substances called encephalins have their powerful analgesic effects on the body by inhibiting pain impulses; the endorphins also possess strong analgesic and behavioural effects. The analgesic compounds are concentrated in the thalamus, the hypothalamus and the pituitary gland. This correlates with what Fitzgerald said in those early years, that stimulation to the pituitary gland reflex point is thought to block or suppress pain. He also elaborated: ‘these functions were carried out by the pituitary body and multiple nerve pathways from it’. It may be that stimulation of the pituitary reflex causes the pituitary body to release adrenocorticotrophic hormone (ACTH), which is released in response to stress, and which controls the release of corticosteroid hormone from the adrenal cortex, a powerful anti-inflammatory substance that helps many of the disorders of the body.


Another function of the autonomic nervous system is that of reflex nervous action. A reflex is an automatic involuntary activity brought about by a relatively simple nervous circuit without conscious control being involved. Thus a painful stimuli will bring about a reflex of withdrawing even before the brain has had time to send a message to the muscle involved. This is a reflex action that has been conditioned by other considerations, it is a protective reflex.

Reflex actions are extremely important. They adjust the tone of muscles, particularly those used in posture. It is for this reason I think reflexology has such a dynamical effect on all the spinal nerves of the vertebrae, improving all back and neck related problems.

The medical profession use reflexes for diagnosing many disorders of the nervous system. The most used one, often referred to in reflexology, is the Babinski reflex sign or plantar reflex; this is brought about by drawing a blunt instrument or stroking the lateral side of the plantar area of the foot from the heel to the little toe. In any person over the age of 18 months old, the normal flexor response would be a downward bunching of all the toes. When there is a reverse upward action of the great toe this is indicative that there may be some evidence of a disorder in the brain or spinal cord.

The hypothesis of reflexology is that the medical fraternity expect a reflex on the foot to indicate some clinical significance enabling them to assess a condition in the body (i.e. they are ‘reading’ the message coming out); a reflexologist uses the same sensory pathway of stimulation to send a message into the peripheral nervous system, which is a two-way circuit, and on into the central nervous system, a vast nerve network, and through the many interconnections here to reach the autonomic visceral reflexes of the sympathetic and the parasympathetic nervous systems that adjust the activity of the organs of the body cavities in the torso.

As reflexologists we work on the feet, dealing mostly with the minute reflexes. The nerve pathways are thought to traverse through the feet and body. Because of this, often when working on patients they feel a shock or stimuli on the opposite side of the body. This is considered to be crossed reflexes. The term ‘crossed reflex’ is often used in zone therapy and reflexology. The original neurological term refers to a response that is brought forth on the opposite side of the body to that on which the stimulus was administered, from ascending nerve tracts entering the opposite side of the brain. The term ‘crossed reflex’ in reflexology indicates an area of referral. This connection affects not only the corresponding organ that has an anatomical connection but also the represented area of the body; for instance, in the case of the head area, we know that if we stub our toe a headache may often develop. Cross reflexes can be used when it is unsuitable to work on a corresponding area, especially if there is any injury or damaged skin; for instance, if the patient has a broken toe, you could get an equal relief of pain by working on the thumb, so the injured part can be avoided. These reflexes can also be used as an area of assistance if the corresponding area is too tender. An area of assistance or helper area is another part of the body that may support or relieve the organ that is injured or has an imbalance through its anatomical connections.

Fitzgerald spoke of the following anatomical correspondences (figure 2.7)

       •  arms and legs correspond

       •  palms and soles correspond

       •  dorsal hands and dorsal feet correspond

       •  fingers and toes correspond

       •  wrists and ankles correspond

       •  hips and shoulders correspond.

This anatomical connection has always been part of TCM.

We know these reflexes are highly complicated and are still not fully understood. As therapists we need to have a knowledge of all these systems of the body thus enabling us to have a greater understanding of how reflexology works. For instance, why is the relaxation on the solar plexus area done on both feet? It was traditionally explained that it was concluded together so as not to cause an imbalance, even though we have only one solar plexus. When we rotate the pressure on the solar plexus point it can be explained in two ways: stimuli to the foot between zones 2 and 3 has a direct connection to the coeliac plexus because we are also rotating on the same area on the right foot. This area on the feet and hands is important when treating depression. The reason for solar plexus relaxation must be that both feet benefit from this dual stimulation. We know that the solar plexus is a strong network of sympathetic nerves and ganglia located high at the back of the abdomen. On the feet and hands the corresponding area lies between zones 2 and 3, just below the diaphragm line. This same area on the feet is the first point of the Kidney meridian (KI-1) according to TCM; it is an essential point for all acute problems, and it is a very effective point for all cases of any urgency. The corresponding point on the hands is PE-8; this is also a very potent effective point and is very dynamic in clearing excess heat from the heart and it has a wonderful calming effect on the mind. The Pericardium meridian originates from the chest area and descends through the diaphragm to the abdomen, another branch shoots off to the nipple and then to the axillary area to descend down the arm to terminate in the large finger (see figure 2.10); this channel is often considered to be connected to the emotions of elation and contentment.

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Figure 2.7 Corresponding cross reflexes

Also when working on a person why does the heart rate slow down? We know that normally cardiac muscle contracts rhythmically without nervous stimulation. The pace is controlled by the autonomic nerves supplying a microscopic group of cells in the upper wall of the right atrium near the entry of the superior vena cava called the sinoatrial node. This area is supplied with parasympathetic fibres from the vagus nerves (tenth cranial nerve) and sympathetic fibres from the cardiac plexus and both end at this point, again receiving this dual stimulation. When stimulated each releases a different neurotransmitter; parasympathetic stimulation releases acetylcholine, slowing the heart rate, and sympathetic stimulation releases adrenaline and noradrenaline, speeding up the heart rate so the rate and depth of breathing are also increased. When working on the reflex points that correspond with these organs the body’s systems know whether the heart needs a boost or needs to be calmed down.

Pressure is known to relieve pain. Fitzgerald spoke of how he induced a state of inhibition throughout a zone when he used pressure, and then many of the pathological processes would disappear. He said, ‘We know lymphatic relaxation follows pressure’. He was repeatedly being called upon to expand on the theory of zone therapy and he stood by the idea that certain control centres in the medulla oblongata are stimulated, or more shocked, when pressure is applied to corresponding areas; alterations in function are then carried out by the pituitary body secretions affecting the many nerve pathways. He believed man to be of chemical formation but controlled by electrical energy and vibration. When Fitzgerald was in Europe he must have come into contact with many articles and papers that were published in those days, by the many neurologists who were studying the disorders of the nervous system.

Fitzgerald stated in his book Zone Therapy that manipulation of the fingers or hand over any injured place prevents a condition known as venous stasis, a state in which the injured surface becomes discoloured. Pressure helps inhibition of the nerve pathways to the brain; also when applied over any bony prominence that corresponds to the location of injury it will tend to relieve pain. If the pressure is correct and long enough it will produce a condition of anaesthesia. This is what led to the discovery of zone analgesia. Fitzgerald also emphasised that it made a difference whether the upper, lower or side surfaces of the joint were pressed. He stated that this pressure therapy had a great advantage over any other method of pain relief because this zone pressure not only relieved the pain, it also removed the cause of pain, no matter where it originated from.

Meridians and nerves

The philosophy of acupuncture and acupressure relies on the connection between a specific area on the skin and a specific organ (see chapter 1). Traditionally these are through the meridian pathways that link the organs. According to some TCM authors, these meridians are not the same as the neural pathways; however, that is a theory expounded by some Western acupuncturists. For example, according to Dr Felix Mann in Acupuncture, How it is Used Today: ‘Nowadays acupuncture can be explained by a wave of electrical depolarisation that travels along a nerve’. This author also refers to the similarity between the TCM idea of Qi transmission along the meridians being like water flowing along a river bed, and the propagation of a nerve impulse along a nerve. Further on in the same book he states:

The mechanism of acupuncture is elusive. Nevertheless, I have developed the following theory which I think will soon be generally recognised as the scientific basis of acupuncture – albeit with modifications and considerable clarification in detail.

If a patient has a pain in the head or neck, it may under certain circumstances be alleviated in one second, by putting an acupuncture needle into the correct acupuncture point in the foot. This speed of conduction, from one end of the body to the other, is only possible in the nervous system. It would take about half a minute for the blood to flow such a distance, and the lymphatic system is even slower.

Acupuncture is based on the fact that stimulating the skin has an effect on the internal organs and other parts of the body.

Many of the meridians follow the line of a nerve, so the neural pathways must be involved; the above theory is open to conjecture, but the evidence is almost conclusive. The same hypothesis is appropriate for reflexology. By stimulating the precise point a response is felt in the body. In an example that Dr Mann gave, if a person had a headache one would work on the brain reflex and head-related areas; the trigeminal nerve reflex has a definite effect on head-related problems, and these points are on the big toe. Also the liver reflex would be worked as the toxin levels would be quite high; this point is on the plantar area of the foot, but there is no meridian depicted here, showing that the response obtained is from the nerve pathways.

Looking at each meridian in detail reveals that many of them follow nerve pathways; these connect with all the structures along their course: the bones and the deeper muscular branches of their respective muscles, organs, arteries and veins. Thus the pathway could be seen as a direct line to the area of the problem and everything connecting with this pathway is potentially helped. Also, a particular nerve pathway goes in one direction, but a two-way transmission is set up through returning nerve pathways. The following looks at each meridian in detail, typical associated disorders and the nervous connections.

The Lung meridian

The Lung meridian (figure 2.8) is a Yin channel with 11 points. This meridian originates in the stomach and then communicates with the paired organ, the large intestine. As it ascends it connects with the relevant organ, the lungs, the first surface point on this meridian is above the nipple in the first intercostal space. The meridian then passes to the throat from the chest and clavicle along the radial border of the arm, to the middle of the elbow, back to the radial border descending to the thenar eminence and ends at the thumb on the lateral edge of the nail bed. This channel not only communicates with its paired organ the large intestine, but also associates with the kidneys and stomach. So points on this meridian (e.g. LU-10) will help fluid problems as well; it is ideal for oedema and retention of urine.

The nerve line arises from the lateral cutaneous branches of the first intercostal nerve, the medial and lateral pectoral nerves, median, radial, interosseus and cutaneous nerves of the arm, which then connect with the dorsal digital branches of the palmar digital nerve.

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Figure 2.8 The Lung meridian (the dotted line shows how it connects with its paired organ, the large intestine)

Disorders of this meridian, with signs and symptoms, include: chills, fevers, hidrosis, anhidrosis; pain above the clavicle, or in the chest, upper back, shoulder, forearm, elbow, wrist and hand; headaches; any nasal obstruction, asthma, cough, dyspnoea; fever; sore throat; trigeminal neuralgia, or any twitches in the face. The thumb point is helpful for any cerebral congestion, insomnia, headache, or nervous anxiety.

The Large Intestine meridian

The Large Intestine meridian (figure 2.9) is a Yang channel with 20 points. It commences on the tip of the radial side of the index finger. It ascends the arm on the lateral surface up to the shoulder connecting to the cervical spine and the Governing Vessel on the back. From here it descends to the clavicle and communicates directly with the paired organ, the lungs, and passing through the diaphragm it connects with the relevant organ, the large intestine, to terminate on the face near the nose.

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Figure 2.9 The Large intestine meridian (the dotted line shows how it communicates with its paired organ the lungs and connects with the large intestine)

The nerve line is along the palmar digital nerves, the median nerve, the radial nerve, the ulnar nerve, and the lateral and posterior cutaneous nerves of the forearm; then the branches of the supraclavicular and suprascapular nerves; then the sternocleidomastoid nerve; finally the facial and orbital nerves.

Disorders of this meridian, with signs and symptoms, include: all problems related to the head, face, ear (but note that a more powerful point is TB-1 and TB-2) and mouth, including toothache in upper and lower jaw; fevers, sore throats, laryngitis, pharyngitis, influenza; neuralgia of the shoulder and arm, especially the humerus and deltoid, pains to and from the fingers to the upper arm and shoulder; intestinal disorders, constipation and diarrhoea, abdominal pain (because of the calming and antispasmodic action it helps any pain and discomfort arising from any of these disorders); salpingitis; inflammation of the uterus, insufficient menstruation, amenorrhoea (see Note below).

Note. There is a vital point, LI-4, that is known as an empirical point to promote delivery during labour; hence it must not be used if the person is pregnant. There are many cautionary warnings on this point.

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Figure 2.10 The Pericardium meridian (this communicates with all three areas of the body through its paired organ the Triple Burner)

The Pericardium meridian

The Pericardium meridian (figure 2.10) is a Yin channel with nine points. It originates in the thoracic area lateral to the nipple, where it connects with the relevant organ, the pericardium. It then passes through the costal region to the axillary area and runs along the medial aspect of the arm to the cubital fossa. It enters the palm to pass through the muscles, palmaris longus and the flexor carpi radialis to the tip of the middle finger and terminates at the medial side of the nail bed. This channel communicates with all three areas of the body through the paired organ, the Triple Burner.

The nerve line is along the fourth intercostal nerve, the medial and lateral pectoral nerves; then the median, interosseus and cutaneous nerves; it then connects with the palmar digital nerves of the median nerve.

Disorders of this meridian, with signs and symptoms, include: mouth disorders, tongue rigidity; spasms in the hand, wrist or elbow; angina, cardiac arrhythmia, tachycardia; chest disorders, costal neuralgia, pleuritis, mastitis; problems of the mind such as epilepsy, hysteria; heat stroke, fevers. Working it has a wonderful, calming action on the mind.

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Figure 2.11 The Triple Burner meridian

The Triple Burner (also called the Triple Energizer or Triple Heater) meridian

The Triple Burner meridian (figure 2.11) is a Yang channel with 23 points. It commences on the ulnar side of the ring finger just below the nail bed. It ascends between the fourth and fifth metacarpals in the dorsal side of the arm, between the radius and ulna bone, to the shoulder region where it contacts the Gall Bladder channel, covering the chest. It communicates with the paired organ, the pericardium; then it descends through the diaphragm to connect with all the areas of the body. The point from the shoulder, which enters just above the clavicle, then goes to the neck and the auricle to terminate at the lateral side of the eyebrow. This channel connects directly to the Pericardium meridian.

The nerve line is along the palmar and dorsal digital nerves; then the ulnar and cutaneous nerves of the forearm, connecting with the radial nerve as the meridian ascends. It follows the supraclavicular, suprascapular and axillary nerves, also the first thoracic nerve. There are tributaries of the great auricular and the lesser occipital nerve; also many of the facial nerves, the zygomatic and trigeminal nerves.

Disorders of this meridian, with signs and symptoms, include: headaches and related problems; eye problems, conjunctivitis; ear pain and tinnitus; sore throats; facial problems and toothache; stiff neck and shoulders. The Triple Burner helps all levels of the body, including problems in the chest, upper and lower abdomen, all digestive problems, and intestinal disorders. As it connects with the ‘Lower Burner’ it also benefits liver, stomach and bladder problems.

As a speculative comment, Fitzgerald would raise the nail of the ring finger on the lateral side to stop unilateral tinnitus; that is the first point on this meridian for any ear problems.

The Heart meridian

The Heart meridian (figure 2.12) is a Yin channel with nine points. It originates at the heart to the medial side of the upper limbs near the axillary area and then descends to the paired organ, the small intestine. There is an offshoot from the heart to the oesophagus, which then ascends to just below the eye. The principal channel ascends from the heart to the lungs, to the axillary area, and follows a line down the ulnar side of the arm to the wrist between the carpals (capitate bone) between the fourth and fifth metacarpals on the palmar side to the little finger; here it terminates at the medial side of the nail bed of the little finger. This channel connects directly with the lung and the kidneys.

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Figure 2.12 The Heart meridian (the dotted line shows how it communicates with its paired organ the small intestine)

The nerve line is along the intercostobrachial nerve, the radial, ulnar, and the median nerve and its branches, also the palmar digital nerve.

Disorders of this meridian, with signs and symptoms, include: headaches, hysteria, insomnia, mild psychiatric problems, disturbing dreams, depressions or anxiety; problems of the tongue such as glossitis, toothache; all arm and wrist pain; chest, respiratory and breast disorders, angina, mild heart problems, irregular heart beat, palpitations; uterine disorders, dysmenorrhoea.

Note. If you suspect any heart disorder, never treat yourself. Seek help first from your medical practitioner. If they are happy that you receive reflexology, this will have a wonderful calming action on the heart.

The Small Intestine meridian

The Small Intestine meridian (figure 2.13) is a Yang channel. It commences on the ulnar side of the little finger, on the lateral side of the arm to the shoulder, passes around the scapula and goes deep to the supraclavicular fossa connecting to the heart, the paired organ, then descends to join the small intestine. An offshoot passes up from supraclavicular fossa to the neck and then on to the cheek; from there it connects with the Gall Bladder and Triple Burner channels and then terminates at the front of the ear.

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Figure 2.13 The Small Intestine meridian

The nerve line is along the dorsal digital and palmar nerves, the ulnar nerve, the cutaneous nerves, the radial nerve, the second intercostal nerve, the suprascapular nerve, the eighth cervical nerve, the first and second thoracic nerves, the great auricular nerve, the auriculotemporal nerve, the superior cervical ganglion, also five of the cranial nerves: the vagus (X), spinal accessory (XI), hypoglossal (XII), trigeminal (V) and facial (VII) nerves.

Disorders of this meridian, with signs and symptoms, include: headaches, febrile symptoms (work on this channel helps to clear the mind); stiff neck and torticollis; wrist, arm and shoulder problems; acute lumbar strain; colic and constipation.

As a speculative comment, Fitzgerald stated that the fourth and fifth zone merged in the head. Note that the three meridians on the third and fourth fingers all deal with head-related disorders: Triple Burner, Heart and Small Intestine. Also the three meridians on the feet, Gall Bladder, Bladder and Kidney, are all points for head-related problems. The first Kidney acupoint arises on the little toe to emerge on the plantar aspect of the foot. In reflexology we would use this point for stiff necks or shoulder problems; just pulling on this toe will help to relieve a stiff shoulder or neck. The spinal accessory nerve supplies the sternocleidomastoid muscle and the trapezius muscle, both of which are involved in neck and shoulder movements. (See figure 7.2.)

The Spleen meridian

The Spleen meridian (figure 2.14) is a Yin channel with 21 points. It commences on the medial edge of the base of the nail bed of the great toe and ascends the leg on the medial side to enter the abdomen; there it communicates with the Conception Vessel (see figure 7.6) where it connects with its relevant organ, the spleen. From here it connects with some of the internal organs, the stomach – its paired organ, liver and gall bladder. The meridian continues up through to the diaphragm, one offshoot going directly to the heart and the other ascending into the throat and root of the tongue.

The nerve line is along the cutaneous medial dorsal nerves of the foot and plantar nerves, then along the saphenous, tibial and femoral nerves, which arise from L2-L4 of the spinal trunk; there it connects with the thoracic nerves, then it continues on up to the intercostal nerves and pectoral nerves.

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Figure 2.14 The Spleen/Pancreas meridian

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Figure 2.15 This tongue pressor was used on the posterior wall of the pharynx to give relief during menstruation. (Fitzgerald made a statement to the effect that while he had not heard of any miscarriages he cautioned its use in pregnancy.)

Disorders of this meridian, with signs and symptoms, include: anything concerned with the brain and central nervous system; spinal problems; all genitourinary problems; abdominal and intestinal disorders, such as flatulence, any abdominal pain, gastric pain, painful haemorrhoids, diarrhoea, constipation, irregular menstruation.

As a speculative comment, SP-3 is used for all lung problems. This point is on the lung area in reflexology. SP-4 is a point that is widely used for all excess problems of the stomach and the spleen; this area corresponds to the upper abdominal area in reflexology. Also the Spleen meridian ends in the root of the tongue; Fitzgerald use to apply a tongue pressor (figure 2.15) to reach as far back as possible on the root of the tongue for amenorrhoea, also for painful menstruation. This point is a good point to regulate menstruation, and the former helps in strengthening the spine.

The Liver meridian

The Liver meridian (figure 2.16) is a Yin channel with 14 points. It commences on the lateral edge at the base of the nail bed of the great toe and ascends the dorsal aspect of the foot to the medial malleolus; then it ascends the leg on the medial side following the line of the Spleen channel. It traverses around the pubis area and the genitals, where it meets the Conception Vessel, then moving onwards and up to its relevant organ, the liver, where it links with the gall bladder. It has branches that serve the lungs, the trachea, the larynx and the upper palate of the mouth, and an offshoot serves the lips. The meridian also distributes to the tissue around the eye, and also the forehead; it meets the Governing Vessel at the vertex of the head.

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Figure 2.16 The Liver meridian

The nerve line is along the cutaneous medial dorsal nerves of the foot and the deep peroneal nerve, then the saphenous, and femoral nerves, which arise from L2-L4 of the spinal trunk; there it connects with the thoracic nerves, then continues on up to the intercostal nerves.

Disorders of this meridian, with signs and symptoms, include: headaches, vertigo and tinnitus; throat disorders, toothache; any colic or abdominal distension due to gastrointestinal disorders; lumbago; and problems in all four limbs; all problems relating to the genitourinary tract.

The Stomach meridian

The Stomach meridian (figure 2.17) is a Yang channel with 45 points. It originates on the cheek at the side of the nose, and passes through the roots of the teeth on to the lips, descending through the thorax to the abdomen, where it communicates with the spleen and connects directly with the heart. It passes down the thigh to just below the knee on the anterior part of the leg to terminate on the lateral edge of the second toe at the base of the nail bed.

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Figure 2.17 The Stomach meridian

The nerve line is along the branches of the facial nerve, then the oculomotor, the trigeminal, and hypoglossal cranial nerves, and the auricular nerve, continuing along the cervical nerves that supply the clavicle, and the first thoracic nerves that supply the pectorals through to the first lumbar nerve, which supplies all the abdomen, and the femoral nerve, which splits into many cutaneous branches supplying the area from the inguinal ligament down to the toes.

Disorders of this meridian, with signs and symptoms, include: all mouth and facial problems; problems of the lower extremities. There is a distal empirical point that can be used for shoulder problems. (See ST-38, figure 5.41.)

As a speculative comment, in reflexology we use the ST-45 and ST-44 for all mouth or facial problems, and these reflex areas are wonderful for toothache. ST-43 is used for all digestive disorders; this lies on the hypochondrium area according to the reflexology map of the body.

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Figure 2.18 The Gall Bladder meridian

The Gall Bladder meridian

The Gall Bladder meridian (figure 2.18) is a Yang channel with 44 points. It originates on the lateral side of the eye at the point known as pupil crevice. The meridian contours the head and neck, with an offshoot passing to the inner ear; it then passes through the diaphragm with branches going to the breast, then it connects with the liver and gall bladder, and emerges in the groin area and runs along the lateral aspect of the thigh down to the lateral edge of the fourth toe at the base of the nail bed. There is also a connecting channel, which links the instep to the first toe, connecting the gall bladder and the liver, its paired organ.

The nerve line is along the branches of the fifth cranial nerve, the largest cranial nerve, whose offshoot the zygomaticotemporal nerve serves the facial area, then along the occipital, and auricular nerves, continuing along the supraclavicular nerve, connecting with many of the intercostal and many of the thoracic nerves, right down to the first lumbar nerve, where the femoral nerve lies, and branches of the peroneal nerve, connecting with many of the muscles of the calf, the dorsal surface of the ankle, the tarsus, the fourth metatarsal and the third, fourth and fifth toes.

Disorders of this meridian, with signs and symptoms, include: all head-related disorders, facial pain, eye, ear and mouth problems, mastitis or oedema of the axillary areas; any pain of the costal region, or neck, arm and shoulder problems.

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Figure 2.19 The Bladder meridian

The Bladder meridian

The Bladder meridian (figure 2.19) is a Yang channel with 67 points. It originates on the face on the medial edge of the eye, contours the head and the neck then descends the lateral side of the vertebrae to connect with the bladder and the kidney. An offshoot from the lumbar area passes around the gluteal muscles of the buttocks to terminate at the popliteal fossa, the depression at the back of the knee. There is a secondary channel running from the neck area down the vertebrae to this point, but this secondary branch carries on down splitting the gastrocnemius muscle of the calf to emerge on the lateral side of the malleolus to run alongside the lateral side of the fifth metatarsal and terminate in the little toe.

The nerve line is along the ophthalmic branch of the trigeminal nerve, the fourth cranial nerve, the trochlear, and the third cervical nerve. It then descends the thoracic nerves that serve many muscles of the back, carrying on to connect with all the lumbar nerves 1–5 and the sacral nerves; it continues down through the buttocks, serving all the hamstring muscles, and along the peroneal nerve, connecting to the digital plantar nerves of the foot.

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Figure 2.20 The Kidney meridian

Disorders of this meridian, with signs and symptoms, include: all head and neck problems; some urogenital disorders; lumbago; foot and leg problems.

The Kidney meridian

The Kidney meridian (figure 2.20) is a Yin channel with 27 points. It originates on the fifth toe and emerges on the plantar surface of the foot, passing to the medial edge of the internal malleolus where it ascends the leg, entering the body at a point at the coccyx. There it runs deeper to connect with the kidneys and bladder through the lungs, to be lost in the roots of the tongue. An offshoot leaves the lungs and connects with the heart to terminate in the clavicle.

The nerve line is along the plantar nerves, connecting with the saphenous and tibial nerve, a branch of the sciatic nerve. It then enters the lumbar-sacral plexus and continues on into the upper thoracic, and intercostal and pectoral nerves.

Disorders of this meridian, with signs and symptoms, include: all head-related disorders of an acute nature; distension or pain of the abdomen or gastritis; most urogenital disorders and irregularities; all lower back and knee problems; most of its problems end in ‘itis’ or are of sudden onset.


By looking at the nerve pathways involved it is possible to answer why working on a meridian or zone has such a powerful outcome. Nerve transmission works on the ‘all or none’ principle, so that the channel will open to stimuli that are strong or long enough; providing there is no congestion of toxic matter the impulse will travel right along the pathway. If there is a blockage then several treatments are usually needed to clear the nerve pathway.

It has been found empirically that the distal points used for acupuncture and acupressure are particularly efficacious. These are in many ways the same points that we may cross at some time throughout the reflexology treatment session. Comparing the two systems, the point SP-1, for example, the first point on the Spleen meridian, is for the nose. This is also the point for the nose in reflexology. Qi is considered to be ascending in this channel. Equally, the last point of the Stomach meridian, ST-45, is known as the ‘sick mouth’, because it is an ideal point to treat those problems at the opposite end of the body. Qi is considered to be descending in this channel. So by treating distal points, and regardless of which way Qi or nerve energy is moving, we get a response. This is exemplified by the aphorism that stubbing your toe gives you a headache, and by the Babinski reflex, the foot indicating what is happening in the brain.

A recent hypothesis to explain the effect of acupressure and acupuncture is that when a needle or pressure is applied at a certain skin depth it seems to stimulate the nervous system in a series of reflex arcs, thus releasing endorphins into the system and producing pain-relieving and opiate effects. We know that the Chinese use acupuncture for anaesthesia and pain relief, and this practice often relieves some other physical symptoms in the process. Acupuncture can be explained by a wave of electrical depolarisation that travels along the nerve pathways activating the deep sensory nerves which cause the pituitary and midbrain to release endorphins, the brain’s natural painkillers. The problem the person is suffering from is often alleviated after a few treatments.

Since the early 1960s, electroanalgesia has been used as a safe and effective method of pain control, regardless of whether it is acute or chronic. There are many manufacturers of electroanalgesic instruments. The theory regarding this therapy is that stimulation by a small electric current, like the stimulation caused by insertion of an acupuncture needle, activates descending inhibitory neurons that block the transmission of pain signals. It is said to ‘close the pain gate’, so this theory is known as the ‘gate control theory’.

The Chinese state in many books that the meridians follow the pathways of the major nerves, and needling or acupressure will activate a point. The nerves lie very close to the bones, and we know that peripheral nerve innervation of the skeleton closely follows muscle innervation. This shows that the same nerve innervates muscles that are attached to that bone. Did Dr William Fitzgerald simplify this whole concept? He stated that pressure over any bony eminence or on the corresponding zone to the location of injury or problem would relieve pain. One of the theories he put forward was that certain control centres in the medulla are stimulated, or that the function is carried out by the pituitary body and its multiple nerve paths from it. He went on to explain that we induce a state of inhibition throughout the body when pressure is brought to bear. When inhibition or irritation is continuous, many pathological processes disappear. He also stated that it was certain that lymphatic relaxation followed lymphatic pressure.

Today there is no concise explanation of the rationale of how or why reflexology works. We as practitioners just accept and know that it does. A recent hypothesis for the effect of acupuncture is that when pressure or needles are applied at a certain depth it stimulates the nervous system in a series of arcs or reflex actions; this may send a motor impulse down a nerve to supply a muscle or gland into stimulation, either contraction or relaxation. One other theory is that this technique stimulates production of pain-relieving endorphins within the brain. These recent theories confirm Fitzgerald’s early thoughts and writings.

The zones and the divisions of the feet and hands

The zones and divisions of the hands and feet according to contemporary reflexology are shown in figure 2.21 and plates 1 to 4. (Note that in the anatomical texts the person is depicted standing upright with the feet on the ground and the palmar surface of the hands are facing the front. In the zonal or reflexology position the body is depicted with the palmar surface of the hands facing towards the posterior part of the body. However, this is not adhered to in all representations of the zones.) The dorsum of the hand and foot represent the anterior surface of the body. The palmar surface of the hand and the plantar region of the foot depict the posterior portion of the body. Each numbered line represents the centre of its respective zone (see figure 2.21). There is considered to be an imaginary line showing the division between the anterior and posterior parts of the body. (Fitzgerald said this was so that when treating any of the viscera, it was usually preferable to treat both anterior and posterior zones simultaneously.)

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Figure 2.21 The ten longitudinal zones on the hands and feet

The theory behind reflexology is that the feet and hands are not just the extremities at the end of our body; these appendicular organs are a somatic reproduction of the entire condition of the body. However, many books show the picture of the human body superimposed on just the foot or hand. This is to outline the need to know the location of the appropriate point for all the principal organs and glands so that they can have pressure applied on the correct area. The distal limbs are not usually shown other than where there is an area that is supposed to connect to the area to work on.

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Figure 2.22 (a) The four curves of the spine represented on the foot. (b) The vertebrae and spinal nerves represented on the foot.

The feet and the spine

The feet are extremely important to the general health of our body, and because of certain similarities reflexology theory considers there to be a relationship between the body and the foot. For instance, there are 26 bones in each foot and there are 26 bones in the adult spine. Further, the vertebral column has four natural curves when it is viewed from the side: the cervical curve is rounded forwards, the thoracic curve is gently curved convex towards the posterior, the lumbar spine is also curved convex forwards creating a hollow, while the sacrum curve is like that of the thoracic curve, convex towards the posterior. The foot appears to have four natural curves also, almost imitating the line of the spine. So the curves and the bones of the foot are designated in reflexology as representing the curves and the bones of the spine (figure 2.22a). From this, particular areas of the foot are considered to represent areas of spinal innervation that correspond to those bones (figure 2.22b).

The following four curves or divisions of the feet represent the four body divisions as follows (the two feet symbolize the whole human body including the limbs, not just the torso).

       1. The phalanges of the feet represent the head, the uppermost division of the body, containing the brain and chief sense organs.

       2. The metatarsus represents the thoracic cavity from the neck to the abdomen, containing our breathing apparatus, the lungs, also the heart and other structures within.

       3. The tarsus represents the abdominal cavity, which is between the thorax and the pelvis area, and all organs and structures within it. The tuberosity of the cuboid bone represents the waistline.

       4. The calcaneus and talus represent the pelvic cavity, the almost bowl-shaped area that is formed by the pelvic girdle and the adjoining bones of the spine; this creates the central support for the body, and is composed of the two hip bones, the sacrum, and the coccyx and organs and structures within.

Reflexology and the body systems

The theory of reflexology is that a congestive state creates blockages of energy pathways; it has been conjectured that this blockage causes crystals to become deposited around the nerve endings, causing congestion right through the zone. The deposition around the nerve endings also causes a painful area when pressed or palpated. Over a period of treatment these areas become less sensitive as changes are induced within the circulatory and the nervous system by means of pressure stimuli. Such stimuli trigger the body’s inherent ability to move back to a state of correct balance and positive health and well-being. Working all areas of the hands, feet or ears and using a combination of reflexes will therefore eliminate most of these blocked energy pathways, energizing and revitalizing the recipient.

The natural homeostasis of living things can be disturbed by stress, which upsets the internal environment. Every part of the body is involved in maintaining this environment within the normal limits. It is only in cases of extreme or severe stress that the body is unable to cope. Homeostatic functions are maintained by nervous and chemical connections, with the pituitary body and other endocrine glands all working in unison. Feedback systems detect even the slightest change, setting off an immediate response in the form of neural impulses which are sent to neutralize any stress this may cause and to counterbalance the organ in question. If the body systems are not functioning at peak efficiency then disorders may manifest.

In the brain, three areas, the medulla oblongata, the hypothalamus and the pons Varolii (figure 2.23), are very important for this process. The first contains vital centres that control the rate and depth of breathing ‘respiration’, the rate of the heart beat and blood vessels, and not so vital centres that control reflexes such as swallowing, sneezing, coughing and vomiting. It also forms the major pathway for nerve impulses entering and leaving the skull. The hypothalamus also contains vital centres controlling body temperature, thirst, hunger, eating, water balance and the libido, and is also closely connected to emotional activity and sleep. The pons Varolii contains many nerve tracts running between the cerebral cortex and the spinal cord; it is where the trigeminal nerve emerges and also the sensory fibres relaying information about pain, touch and temperature.

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Figure 2.23 A section through the brain

We can therefore see that reflexology might assist the homeostatic function by removing obstruction at the level of the autonomic nervous system. Fitzgerald said all zones must be free from irritation and obstructions for best results. He spoke of all existing pathological conditions being relieved and some even cured by zone therapy. He stated, however, that his work was not a panacea to all ills, but he was glad to offer his knowledge of zone therapy to physicians, surgeons and patients/clients to aid medicine and surgery and for them to make use of it in the practice of their profession.


This section has examined how the ideas of acupuncture, acupressure and reflexology relate to our present knowledge of the nervous system. The main practical difference between the three therapies is that reflexology and acupressure are less invasive and they use the fingers or thumbs for manipulation on given points; but they are equally powerful, often bringing quicker relief from the presenting symptoms. Acupuncturists use needles to stimulate very precise points located according to TCM theory, and can reach a greater depth. Acupuncture treatment is often thought to have longer-lasting effects than massage treatment, but can take longer to work.

There are also many contraindications to acupuncture: certain nerves must never have needles applied to them, and many conditions cannot be treated if the person is already depleted by a great emotional experience, or if they are too fatigued. However, reflexology and acupressure are completely safe with only a few cautionary warnings of the timing of treatment sessions; they cannot make a problem worse if applied in the correct way.

Western medicine and complementary medicine working together

Western medical science has overcome so many things. The prevention, diagnosis and treatment of disease have benefited greatly by the development of injections and vaccinations, and of sophisticated surgery incorporating pain management, anaesthetics, antibiotics, and vital organ transplants. However, it is still powerless to treat a lot of the common everyday ailments, and is still largely unable to relieve the emotional and stress-related problems that we suffer from today without resorting to the use of drugs.

The definition of medicine does not include only substances used for treating disease; it also involves the wider art and science of treating and understanding disorders, which includes their prevention, and the maintenance and restoration of health. We need to realize there are alternatives to drugs. Drugs suppress rather than cure the problem; also, they form only part of the total care of the patient. It is not my purpose here to emphasize the differences between reflexology and Western medicine, but to show that the two should work hand in hand and share their knowledge. However, disquiet about the safety of some of the day to day medicines has led to a growing refusal by people to accept the attitude of some doctors that ‘you will have to learn to live with it’. They also may find it frustrating when visiting their general practitioners (GPs) to find that only a few minutes can be spent with them. Not all GPs are so rushed, though, and, more than ever, many are now adopting a more holistic approach to their patients. Many treatments formerly considered ‘alternative’ are now being included in some general practices. For example, GPs may often incorporate counselling, hypnosis, psychotherapy, but also include some of the complementary therapies; the latter include reflexology, which can be administered by non-medical but qualified practitioners.

Even so, often powerful drugs are given, which take away symptoms fast, yet may do nothing to correct the underlying cause. The real cause could be that you are angry with your partner, or that you are having problems at work, or you could be in a non-fulfilling job. All of these types of problems create stress, and in turn many disorders such as troubles with the digestion, headaches or back problems. The drugs that are prescribed may provoke new problems or cause more side-effects than the original illness. For instance, tranquillizers are often given in times of extreme stress, but can easily become addictive. As reflexologists know, side-effects of such drugs can cause sore spots in the reflexes of the hand, feet and ears.

The medical profession themselves are still uncertain as to the safety of the chemicals referred to as medicine or ‘prescription drugs’. No drug is ‘safe’ in the sense that it can never harm anybody; the dose may be critical, and one person may not be able to take the same amount as another. Furthermore, regardless of how clear instructions are, human error can create difficulties with proper usage. Patients are more aware now of the possibility of side-effects and contraindications to some drugs than ever before. However, many people buy vitamins, patent medicines and other remedies over the counter and these also are not entirely free from side-effects. For instance, vitamins are important for good health, but if taken in excess can cause toxic effects and sometimes an allergic response. It is common knowledge that we have become a nation of pill takers, and often the temptation to take medication is at its greatest when we are unable to seek medical advice. There is always a temptation to indulge in self-medication, but a sensible selection of basic medications for everyday needs is all that is required. No drug should be taken casually or carelessly.

Drug dependence is a term that is now used daily; it indicates that the person suffers in some way if the medication is stopped. This effect is typical of the benzodiazepine group of drugs, which act as a depressant on the central nervous system. These common tranquillizing and antianxiety drugs cause the body to become tolerant to a given dosage, so the dosage has to be increased, causing the person gradually to become dependent. As holistic practitioners, we have a responsibility never to encourage patients to come off any drugs, as this issue is between the medical practitioner and the patient and usually drug treatment must be decreased gradually. However, it is possible to encourage patients into making sure the GP is aware of their feelings if they wish to pursue a more holistic approach, as there are alternatives. Natural healing therapies may be time-consuming in the long term, but are generally less invasive and in many cases far more effective. Complementary treatments such as reflexology are a sensible idea for the busy GPs in these situations, and may even save the medical profession a lot of extra expense and time.

Patients are also guilty of pressuring doctors, and some people expect to be given a prescription, feeling that they must not leave empty-handed. These type of people are often not receptive to the concept of holistic medicine. However, drugs and surgery should be used as a last resort, not as a routine measure. The members of the medical profession themselves are now becoming more hesitant in the use of operations, for instance the removal of tonsils, which used to be a standard childhood procedure, or appendectomy, which was formerly often performed routinely when doing other routine procedures for abdominal surgery. Even the extent of vital radical surgery such as a mastectomy or a Caesarean is being re-examined for necessity.

When the British Medical Association set up a committee to look into alternative medicines, they were interested in looking at the effects of alternative therapies as measured by science-based research, which demands measurable proof that a patient’s condition has been improved. To date, however, there have been very few clinical trials. Therefore a scientific inquiry is needed into the efficacy of reflexology, to test the fact and to elucidate on our theories, different levels of pressure must be adopted for true verification of relief of symptoms and pain. As practitioners, we know reflexology is a therapy that gives measurable benefits and in some cases relieves the problem completely. However, for the scientific community just feeling better is not enough proof.

Many doctors now use acupuncture for pain relief. That said, many do not use the TCM ideas of affecting the energy flow to give a complete comprehensive treatment of the whole person. They adhere to scientific research showing that acupuncture works by stimulating nerve fibres to send out pain-blocking messages stimulating production and release of endorphins and encephalins. Reflexology cannot be so wholeheartedly and equally accepted by them unless it can also be explained in this way. This may be at odds with the ideas of complementary therapists who claim that their sensitive hands or fingers feel ‘blockages’. Nevertheless, as practising complementary practitioners, healing the whole person is of paramount importance.

Within the therapy session, sympathetic listening and talking become a way of communicating and healing, in which anxieties are reduced and a more positive attitude of mind is encouraged to bring about swift healing, in which individuals also adopt more self-help measures. Relaxation is a must and it is an essential part of acquiring physical and mental well-being to relieve day-to-day tensions and stresses. There are so many techniques that can be encouraged for relaxation: for example, simple breathing exercises calm the mind and body, and many ancient traditions used breathing to alter mental states. Many methods use this, including meditation and yoga and, over the last decade, Tai Chi and Qigong; the latter ancient arts also include focused awareness and relaxed exercises. Daily use of these methods is reputed to increase a resistance to ill-health and in many cases cure the disease, improve the digestive and circulatory systems, enhance many of the internal secretions and increase vigour. Some research seems to substantiate these claims.

A reflexologist working on the solar plexus and diaphragm reflexes points also often induces a state of calm. It is recognized that different breathing patterns are connected to general health problems and anxious people often breath more rapidly, causing shallow breathing, which robs the tissues of oxygen and nutrients. Reflexology is not a cure-all, but it has been used to treat many common ailments and apparently can significantly reduce anxiety and stress.

3 Basics of consultation and diagnosis

The Fundamentals of Good Practice

This chapter analyses the process of consultation and diagnosis, which are the essential prerequisites to deciding on the correct treatment.

The first steps in consultation are to observe, question and listen to the patient/client in order to understand the problem. All the information gained should be recorded in a case history, using a consultation card or index card.

There needs to be a thorough diagnostic analysis prior to commencement of treatment, through a methodical appraisal of the feet, hands and ears (see also chapters 5–7 for specific areas). The therapists should be aware of behaviour patterns and how they may affect the patient/client’s health. Other factors that may be important need to be considered also. For instance, environmental factors may be affecting the patient/client. These processes lead to a differential diagnosis to understand the cause of the patient/client’s problem.

Finally, the therapist needs to decide on and recommend a treatment. However, there may be patients/clients for whom treatment is contraindicated, and the reflexologist needs to be aware of these.

The general order of the consultation process is therefore as follows:

       •  observation

       •  questioning and listening

       •  diagnosis

       •  recommending treatment.

Clinical observation

Observation should include both observations of the body generally, and detailed observation of the feet.

General observations

General appearance should always be noted; this can only be achieved by a methodical scrutiny of the person as described below to give some idea of their problem.

Being aware of and paying attention to the movement and the physical mannerisms of the person entering the room is of the utmost importance, as many things are noticeable in the first few minutes. These are important as people do not consciously adjust their movements or their mannerisms whilst unaware that they are being observed.

When walking, for example, do they walk on their heels? This could indicate hypersensitivity in the plantar region of the foot, which may indicate peripheral neuropathy. If there is a spring in the step it indicates that the supportive ligaments and muscles are well developed and there is less probability of a spine problem. Is the person flexible in movement when walking? This is a good sign and it shows there is little tension in the body. If the reverse is evident it often indicates the patient is stiff and rigid, and shows that the muscles are tight. This could be due to a muscle injury, a neurological disorder and even arthritis affecting the joints.

The position of the head is important to note. When the body is in the correct position the head is straight and lifted up, the shoulders are relaxed, and this indicates a lack of tension in the person. When the body leans forward it may create pressure on the cervical region, and pressure on the frontal area of the brain; this is thought to be a contributing factor to depression. It also causes pressure on the lower lumbar spine because the weight is not central. The word ‘depression’ means ‘pressure’ or ‘weighing down’; a posture with a dropped head and hunched shoulders may signify that the person is in a low state of mind. Such a posture can in turn cause pressure on the thoracic cavity and abdominal organs. If the shoulders are drawn in the breathing capacity is also diminished; this lowers and impairs the ability of the circulating blood to reach all areas of the body. Many of the problems associated with rounded shoulders are those linked with respiration, such as asthma, bronchitis and upper respiratory infections.

When clients are seated, the therapist should note the following. Are they relaxed? Are the hands held still and at ease, showing a state of calmness and peace, or are they fidgeting, squeezed or twisted in a wringing action, showing unease and discomfort? Other visible signs of unease include plucking of hair and other movements. For instance, do they cross and uncross their legs, cross their feet, or move around? Attention should also be paid to clients’ speech. For instance, do they speak fast without drawing a breath? What is the tone of the voice; is there modulation, or is it high pitched?

All of these behaviour patterns could indicate unease, but there are other explanations. For instance, continual leg movements could be due to discomfort in the lower back or hip area. We should not make a hasty diagnosis, or jump to conclusions. However, the initial observation should enable the therapist to begin to form an assumption of what the problems may be.

A number of specific features can also be observed and are particularly significant.

Facial skin colour and tone

Difference in skin colour is due to the amount of melanin pigment in the skin. However, a good pink facial colour in fair-skinned people is a sign of a healthy circulation and general good health, as the colour of the skin also depends on the quality and quantity of blood moving through the capillaries. Erythema or redness of the skin can be due to many factors; for instance, the client could have rushed to make their appointment, they may be a little embarrassed, or there could be some allergic reaction (as in hives where the skin is often red and irritating). Any undue redness of the skin should be therefore investigated further. Pale skin may indicate a reduced blood flow, or excess time spent indoors, or just that person is enervated by their problems. A grey appearance may indicate illness or total exhaustion; it could even be caused by a lack of oxygen due to respiratory problems. A greying colour can also occur after a sudden shock.

Dry skin or moistureless prematurely aged skin may be indicative of a hormonal imbalance or that the diet is lacking in some nutrients. Any acne, pustules, pimples and spots is nature’s way of discarding toxins through the skin. They indicate that the endocrine system may be out of balance, and diet, hygiene and lifestyle may need to be addressed. If the problem is acne, the sebaceous glands may have become blocked, or it could also be due to an allergic reaction to other substances.


The ears should have the same colour and tone as the facial skin. However, if there is a slight red tinge around the edges this could indicate an uneven blood circulation. If there is a bluish discoloration it may indicate a lack of oxygen and a deficient circulation. Pallor of the skin here in comparison to the face also shows inadequate circulation. (Note, however, that the outside temperature must be noted when doing ear analysis.) Dry skin or exfoliation of the upper layer indicates a possible imbalance in the diet. (See chapter 7 for more information on the ear.)

Hair quality

Good health is shown by bright shining hair; poor health is indicated when the hair is dull and lifeless. If the hair is thinning excessively there could be an immunological disorder; this could also occur after an illness, or even excessive dieting. Brittle hair could signify a mineral deficiency or endocrine imbalance, because the endocrine system is responsible for the stimulation of the sebaceous gland – sebum helps hair from drying out, but too much sebum can create oily hair.

Lips (labia)

The lips should be moist and of a pink healthy colour; this indicates good health and good circulation to the peripheral parts of the body. As the lips are extremely sensitive and have numerous sensory receptors they are often prone to allergic reactions from cosmetics, which can make them appear cracked, dry and sore looking. Also it is necessary to see whether the person produces sufficient saliva (see below), as this also aids lip moisture. How lips and mouth are held gives a good indication of how the person feels; tight pursed lips often indicate tension or unhappiness.

Mouth (buccal cavity)

A dry mouth can be due to incorrect breathing through the mouth, or lack of saliva. This watery secretion containing enzymes begins the process of digestion, and a lack of this secretion could cause constipation or sluggish bowel action. The secretion is entirely controlled by the nervous system, so can be affected if the person is overstressed. It usually indicates that the sympathetic and parasympathetic nervous systems are not in tune with each other.


It is not in the remit of the therapist to take over the diagnostic role of the medical practitioner. However, certain signs do help make an overall assessment of the client’s general health. A large flabby tongue often indicates general weakness or possibly the onset of some debility. A furred tongue is often evident if the person constantly breathes through their mouth or is a heavy smoker. In some cases a thick tongue coating could signify a gastric disorder or some other disorder that may be in the process of manifesting. An even, red and shiny tongue could be due to a nutritional disorder. Constipation or an imbalance in the bowels can also cause cracks and crevices together with a heavy coating that appears yellow and brownish.


Note should be taken of the general appearance of the eyes. Iridology is an ancient diagnostic tool; the iris patterns, just like fingerprints, are unique to each individual. They help the therapist to see whether the patient is predisposed to ill-health or is generally in good health. As this is quite a complex subject it cannot be covered in any depth here. However, the iris is like the feet and hands a microcosm of the body; each organ has its corresponding position in the iris, and anything abnormal such as a mark or discoloration is an indication of an imbalance. There is in particular a close connection between the central nervous system and the eyes. White ‘nerve rings’ around the iris may be due to some emotional upset or trauma. Small pupils indicate some nervous irritation.

Bright, clear eyes with a clear sclera or outer coating indicate good oxygenation to the eye and general good health. Lacklustre eyes indicate an indisposition. Dry eyes may be due to a nutritional imbalance. Yellow discoloration is symptomatic of a toxic system.

All the above observations should be taken together and are useful in assessing the overall well-being of the body. For instance, four of the senses are used throughout the analysis of the feet: hearing, sight, smell and touch.

       •  Hearing – this is used during the initial consultation and assessment process. If the breathing is laboured it could mean a respiratory problem. If the breathing or speech is too fast this could indicate the person is stressed. If a patient sighs this could be indicative of depression.

       •  Sight – observations are utilized throughout an assessment session, particularly noting behaviour patterns and imperfections.

       •  Smell – this is a vital factor that is often overlooked and should be used throughout the assessment session.

       •  Touch – this is an essential factor to help assess the client’s vitality and to note whether there are any imbalances.

Observation of the feet

By looking at the body and comparing it with the feet or hands we get a complete picture of the size and shape of the person. The term ‘mirror image’ when applied to the feet or hands is misleading as this implies that the representation is seen with the right side of the body appearing on the left foot or hand and the left side of the body on the right foot or hand. The term ‘microcosm’ fits the description much better, as the feet and hands represent all the characteristics and attributes of the body. Each organ or part has its corresponding area on the feet, hands or ears.

If the person is short and rotund the feet will show these characteristics also, while if the person is tall and thin this will also be seen in the feet. Even the length of the toes are exactly like the proportions of the neck. If there is an imbalance on one side of the body this is immediately duplicated in the foot.

The longitudinal arch of the foot parallels the shape of the adult spine. The vertebral column also has four natural curves when it is viewed from the side, and the foot has four natural curves almost imitating the line of the spine (see chapter 2 for more details). So if the person had a flat foot (pes planus) this would indicate a bad spine, which would interfere with the flow of nerve energy and the circulation.

The foot areas are represented in figures 2.21, 2.22a and 3.1 and plates 1 and 2. The phalanges (toes and fingers) correspond to the cranial cavity, which houses the brain and all its principal parts. Each toe or finger should be in the same plane when you look at the person, if one toe or finger is higher than its opposite partner, that corresponding eye is also set higher on the face. If the little toe or finger curves in towards the fourth toe and third finger respectively is somewhat tucked under, it invariably reflects an imbalance in the shoulder area.

The metatarsals in front of the ball of the foot correspond to the thoracic cavity, the upper trunk between the neck and the diaphragm, housing the lungs, heart, oesophagus and their associated structures.

The abdominopelvic cavity is represented by the foot between the ball and the heel. It is divided into two parts: the first, between the ball and the midfoot, signifies the diaphragm down to the umbilical area, containing the organs of digestion: the stomach, liver, gall bladder, pancreas, spleen and a small portion of the small intestine. The second, from the midfoot to the heel, represents the central and the lower portion of the abdominal cavity to the pelvic cavity containing the small intestine and most of the large intestine. (There is a slight overlap of the three cuneiform bones into the abdominal cavity.)

image 118

Figure 3.1 The lines of the foot

The tarsals (the seven bones of the ankle) correspond to the pelvic cavity, which contains the genitourinary tract and the last portion of the large intestine.

So there are four natural divisions of the foot and we can also divide the hand into four parts. In addition, specific lines on the foot are believed to represent lines on the body. These are as follows (figure 3.1):

       •  Shoulder or neck line – this divides off the phalanges, and the head-related and neck muscle areas.

       •  Diaphragm line – this includes the distal point of the metatarsals and metacarpals, covering the upper part of the body: the chest, lung and breast, also heart and upper back muscles. (See plates 1 and 3.)

       •  Waist line – the waist line is measured on the foot from the fifth metatarsal tuberosity (the protuberance at the proximal base) on the lateral aspect. On the hand it is measured from just below the fifth metacarpal on the ulnar side (see plate 4). This is found when the fist is clenched to form a transverse crease. The area between the waist line and the diaphragm line covers the middle section of the body: the liver, gall bladder, kidney, adrenals, stomach, pancreas, spleen and solar plexus.

       •  Heel line – the waist line down to the heel line covers the intestinal areas, also the bladder, pelvic and buttock areas. It is found in line with the medial malleolus encircling the heel to the lateral malleolus. On the hand, it is taken from the trapezium bone and the proximal point of the first metacarpal where the muscles bulge at the base of the thumb (thenar eminence), to the middle of the hypothenar eminence on the ulnar side.

       •  Ligament line (on the foot) – this is a guide line. First work either side of it; at the end of the treatment session you should be able to work on it.

As an example for diagnosis, you can examine the fifth metatarsal notch to assess the waist line. If there is a greater proportion of the foot in front of this imaginary line it denotes that the person is long waisted, but short in the leg; if the reverse is true, this denotes that the person has very long legs. If the medial malleoli at the lower end of the tibia are not level it indicates a low lumbar problem.


This aspect of diagnosis, whether using a Western or an Eastern system, can be summed up by an old Chinese quotation called the ‘ten askings’:

       •  One, ask chill or fever

       •  Two, ask perspiration

       •  Three, ask head or trunk

       •  Four, ask stool or urine

       •  Five, ask food intake

       •  Six, ask respiratory

       •  Seven, ask deafness or thirst

       •  Eight, ask past history

       •  Nine, ask energy

       •  Ten, ask causes (nowadays we would look at behaviour patterns and lifestyle).

This ancient Chinese system is still used today even in the West. In reflexology we must ask questions, not necessarily to find the nature of the disorder, but to ascertain which organ or part of the body may be in a disturbed state. When palpating on the feet, hands or ears we can also diagnose imbalances by tender spots; however, painful reactions can be caused by all sorts of variables.

During questioning the reflexologist should note carefully what the patient is complaining of. Specific questions may include the following:

       •  Onset – is the disease or disorder acute or chronic?

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